Two-Stage Treatment for Total Knee Arthroplasty Infection Utilizing an Articulating Prefabricated Antibiotic Spacer

J Arthroplasty. 2020 Mar;35(3S):S57-S62. doi: 10.1016/j.arth.2019.10.049.

Abstract

Periprosthetic joint infection represents a serious complication following total knee arthroplasty. In the setting of chronic or age-indeterminate total knee arthroplasty infection, a 2-staged approach has been traditionally the preferred method of treatment over single-stage debridement and reimplantation debridement or debridement, antibiotics and implant retention. Two-stage is the preferred treatment method in North America and has demonstrated better overall success than the single stage techniques. Additionally, the 2-stage method is the preferred treatment for difficult to treat pathogens as well as in patients who have already undergone a previous revision procedure. An articulating prefabricated antibiotic spacer has entered the armamentarium of 2-stage revision knee surgery, and has demonstrated comparable results to custom and static spacers in terms of the primary goal of infection control. Importantly, the potential for enhanced mobility and function hold promise by safely providing a more "livable" knee during the convalescent period prior to definitive reimplantation.

Keywords: articulating prefabricated spacer; infection; periprosthetic joint infection (PJI); revision TKA; total knee arthroplasty (TKA); two-stage.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Arthroplasty, Replacement, Knee* / adverse effects
  • Humans
  • Knee Prosthesis* / adverse effects
  • North America
  • Prosthesis-Related Infections* / drug therapy
  • Prosthesis-Related Infections* / surgery
  • Range of Motion, Articular
  • Reoperation
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents