Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision

Introduction: Deep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later reimplantation of a revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results. Patients and methods: Twenty-three patients treated with an articulating spacer were retrospectivelystudied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed. Results: A total of three (13%) re-infections occurred 5-20 months after revision total knee arthroplastyin a mean followup period of 47 months. Prior to re-implantation, flexion with the articulating spacerranged between 15 and 100 degrees (mean 68 +/- 28 degrees). The average postoperative flexion after re-implantation of total knee replacement was 105 +/- 11 degrees. Conclusion: The articulating spacer used in this study appears to be as effective as the standard procedures in terms of reinfection risk rate and postoperative range of motion recovery. Level of evidence: Level IV. (c) 2014 Elsevier Masson SAS. All rights reserved.