Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint infection

Purpose Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021-11, Vol.29 (11), p.3621-3632
Main Authors: Woon, Colin Y. L., Nguyen, Joseph, Kapadia, Milan, Russell, Celeste A., Henry, Michael, Miller, Andy, Westrich, Geoffrey
Format: Article
Language:English
Subjects:
Anterior cruciate ligament
Antibiotics
Arthroplasty (knee)
Cement
Infections
Joint diseases
Joint surgery
Joints (anatomy)
Knee
Medicine
Medicine & Public Health
Orthopaedic implants
Orthopedics
Patients
Prostheses
Risk analysis
Risk factors
Spacers
Sports Medicine
Surgeons
Survival
Transplants & implants
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Summary:Purpose Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors that most influence post-reimplantation prosthesis (PRP) survival were determined. Methods A retrospective database review of patients undergoing two-stage exchange arthroplasty from 2008 to 2014 was performed. There were 85 patients, 25 patients and 30 patients in CBS, NEW and ACL groups, respectively. Patient, disease and surgical characteristics were collected and analyzed. Post-reimplantation prosthesis (PRP) survival was modeled using the Kaplan–Meier method. Cox proportional hazard modeling was then performed to identify risk factors associated with implant failure. Results Overall PRP survival was 82% in 140 unilateral TKAs. PRP survival between groups was 81%, 96% and 73% within the minimum 2-year follow-up period, respectively. There was a difference in median interval-to-reimplantation between groups (CBS, 72.0 days; NEW, 111.0 days; ACL, 84.0 days, p  = 0.003). Adjusting for time-to-reimplantation, NEW spacers demonstrated greater PRP survival compared with ACL spacers ( p  = 0.044), and a trend towards greater survival compared with CBS spacers ( p  = 0.086). Excluding early failures (
ISSN:0942-2056
1433-7347
DOI:10.1007/s00167-020-06325-6