Intraoperative Cement-on-Cement Antibiotic-Loaded Articulating Spacer for Treatment of Infected Total Knee Arthroplasty: Description and Results of A New Technique
Piya Pinsornsak MD1, Santi Rodjanawijitkul MD1, Krit Boontanapibul MD2
Affiliation : 1 Department of Orthopaedic Surgery, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Department of Orthopaedic Surgery, Chulabhon International College of Medicine, Thammasat University, Pathumthani, Thailand
Background : Two-stage exchange revision total knee arthroplasty [TKA] is the gold standard for treating a chronically
infected TKA. Application of a cement-on-cement antibiotic-loaded articulating spacer in the 1st stage exchange arthroplasty
provides a good functional outcome during the interim between stages, easy surgical exposure for the 2nd stage exchange
revision arthroplasty, and excellent infection eradication.
Objective : To describe the intraoperative use of a cement-on-cement antibiotic-loaded articulating spacer made with a new
type of mold and evaluate the clinical results.
Materials and Methods : A retrospective case study was conducted of eight patients, mean age 71 years (range 62 to 84), who
between 2011 and 2016 had been diagnosed with chronically infected TKA and who had undergone a two-stage exchange
revision TKA using a cement-on-cement antibiotic-loaded articulating spacer. The mean time between the first and second
stage operations was 4.5 months (range 3 to 7 months). The mean follow-up time was 26.75 months (range 12 to 40 months).
Results : No recurrence of infection was found in any of the patients. All functional outcomes improved compared to the
preoperative period: Knee Society Score rose from 30 to 86, functional score increased from 16 to 81, and knee flexion
increased from 68.2° to 104.7°. No spacer-related complications were seen in any of the patients.
Conclusion : Preliminary results, based on a small sample of eight patients, indicate that the technique of intraoperatively
using a cement-on-cement antibiotic-loaded articulating spacer for treatment of chronically infected TKA provides good
results in eradication of infection, improvement of functional outcome, and absence of spacer-related complications.
Keywords : Infected total knee arthroplasty, Cement spacer, Antibiotic-loaded articulating spacer, Chronic infection, Two- stage exchange, Revision total knee arthroplasty
