Abstract
Background: Standard treatment of chronic infected total knee arthroplasty (TKA) is a two-stage revision, the first step being placement of an antibiotic-impregnated cement spacer. Here we describe the results of a new technique (modification of the Goldstien’s technique) for intraoperative manufacture of a customized articulating spacer at minimal cost and with relatively good conformity and longevity.
Materials and Methods: Thirty-six infected knees underwent this procedure from June 2002 to May 2007. The technique consists of using the freshened femur and tibia interface as molds wrapped in a tin foil for manufacturing the two components of the spacer with antibiotic-impregnated methyl methycrylate cement. We used the spacer and the femoral component of the trial set of a TKA system to mold them to perfect articulation. We also reinforced the spacer with a K-wire scaffold to prevent fracture of the cement mantle in the last 21 cases.
Results: All 36 knees showed excellent results in terms of infection control, mobility, and stability. There was signifcant improvement in the WOMAC and Knee Society Scores (20 and 39 points respectively). There were two fractures of the spacers in the initial 15 cases that did not have K-wire scaffolding but none in the last 21 that had reinforcement.
Conclusion: This technique provides a more conforming spacer, with good range of motion and stability. The reinforcement helps in preventing the fracture of the cement mantle and is cost effective.
Similar content being viewed by others
References
Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am 1983;65:1087–98.
Hsieh PH, Chen LH, Chen CH, Lee MS, Yang WE, Shih CH. Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer. J Trauma 2004;56:1247–52.
Deshmukh RG, Thevarajan K, Kok CS, Sivapathasundaram N, George SV. An intramedullary cement spacer in total hip arthroplasty. J Arthroplasty 1998;13:197–9.
Nazarian DG, de Jesus D, McGuigan F, Booth RE Jr. A two-stage approach to primary knee arthroplasty in the infected arthritic knee. J Arthroplast 2003;18(7 Suppl 1):16–21.
Pitto RP, Spika IA. Antibiotic-loaded bone cement spacers in two-stage management of infected total knee arthroplasty. Int Orthop 2004;28:129–33.
Meek RM, Masri BA, Dunlop D, Garbuz DS, Greidanus NV, McGraw R, et al. Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg Am 2003;85:1888–92
Goldstein WM, Kopplin M, Wall R, Berland K. Temporary articulating methylmethacrylate antibiotic spacer (TAMMAS): A new method of intraoperative manufacturing of a custom articulating spacer. J Bone Joint Surg Am 2001;83(Suppl 2 Pt 2):92–7.
Kuechle DK, Landon GC, Musher DM, Noble PC. Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement. Clin Orthop Relat Res 1991;264:302–8.
Raker DM, Vansow PC. Antibiotic elution from acrylic bone cement in clinical setting for spacers in knee and hip. Clin Orthop Relat Res 1993;153:163–7.
Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res 1995;321:45–54.
Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP. The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 2000;82:807–12.
McPherson EJ, Lewonowski K, Dorr LD. Techniques in arthroplasty: Use of an articulated PMMA spacer in the infected total knee arthroplasty. J Arthroplasty 1995;10:87–9.
Meek T, Muncie M, Tarbox TR, Higgins LL. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relat Res 2002;404:132–8.
Kohl S, Krueger A, Roeder C, Hartel M, Kohlhof H, Schneider C, et al. An aluminium mould for intraoperative production of antibiotic-loaded PMMA knee prostheses. Acta Orthop 2009;80:389–91.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Garg, P., Ranjan, R., Bandyopadhyay, U. et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. IJOO 45, 535–540 (2011). https://doi.org/10.4103/0019-5413.87126
Published:
Issue Date:
DOI: https://doi.org/10.4103/0019-5413.87126