Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability

Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection In cases with extensive bone loss and ligament instability such spacers may not preserve limb length Joint stability and motion We report a retrospective case series of 19 consecutive patients using a custom made cobalt chrome hinged spacer with antibiotic-loaded cement The SMILES spacer was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%) tumour endoprosthesis in four patients (21%) primary knee replacement in two patients (11%) and Infected metalwork following fracture or osteotomy in a further two patients (11%) Mean follow up was 38 months (range 24-70) In 12 (63%) patients infection was eradicated three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second stage surgery Above knee amputation for persistent infection was performed in two patients In this particularly difficult to treat population the SMILES spacer two stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation (C) 2009 Elsevier B V All rights reserved