A Mid‐term Follow‐up Study on the Reimplantation of Autoclaved Femoral and Tibial Components as Spacers for Treating Infected Total Knee Arthroplasty

• Published in: Orthopaedic surgery Vol. 14; no. 9; pp. 2042 - 2049
• Main Authors: Li, Peng, Zhu, Zhiqi, Tang, Xiangyang, Shi, Zhanjun
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-09-2022; John Wiley & Sons, Inc; Wiley
• Subjects: Antibiotics; Arthroplasty; Blood; Care and treatment; Clinical; Component; Debridement; Disease control; Disinfection; Health aspects; Implants, Artificial; Infection; Infections; Inflammation; Joint replacement surgery; Knee; Medical research; Medicine, Experimental; Patients; Polyethylene; Polymethyl methacrylate; Prostheses; Prosthesis; Pulmonary embolism; Range of motion; Replantation; Spacer; Transplants & implants
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13402

Objective
Infection after total knee arthroplasty (TKA) is a rare but devastating complication. Different types of spaces have been used in two‐stage revision. The study aimed to evaluate the effect of autoclaved femoral and tibial components as spacers for treating periprosthetic infections after TKA.
Methods
A retrospective study was performed for 13 patients (five males, eight females) with a mean age of 69 ± 6 (range, 57–80) years and suffering from periprosthetic infection after TKA. They were treated with unconventional two‐stage revision from May 2008 to June 2017. In the first‐stage surgery, the autoclaved femoral and tibial components were reimplanted with a new liner as a spacer after a thorough debridement. After 4–6 months, the second‐stage surgery was performed according to the patients' requirements. The knee society score (KSS) and knee range of motion (ROM) were assessed before and after surgery. The reinfection rate was calculated.
Results
The mean duration of follow‐up was 5.7 ± 2.1 (range, 3.1–8.8) years. Culture‐positive infections comprised 69% of the cohort. All patients were able to walk 24 h after the first stage surgery, and the knee ROM could reach 90° in 1 week. Two patients (15.4%) experienced an infection recurrence. One patient was reinfected 1 year after the first stage surgery. Another patient developed reinfection 3 years after surgery but did not choose re‐revision and died of pneumonia. Only one patient underwent the second stage revision. The remaining 10 patients refused to receive a new prosthesis. At the time of the final follow‐up, six patients had slight pain in the knee while walking, and one patient required crutches to walk. There were no signs of prosthesis dislocation, rupture, deep vein thrombosis, pulmonary embolism, or delayed wound healing. No radiolucent lines or osteolysis were found. The mean KSS improved from 51 ± 10 (range, 35–63) points preoperatively to 79 ± 5 (range, 60–85) points at the final follow‐up. The average ROM before and after the first stage surgery were 62° ± 29° (range, 10°–100°) and 104° ± 9° (range, 90°–120°) (t = 4.659, P < 0.01) respectively. The infection control rate was 84.6%.
Conclusion
Reimplantation of the autoclaved original femoral and tibial components as an articulating spacer during the first stage surgery is a valuable addition for treating an infected TKA.
Use autoclaved femoral and tibial components as spacers in two‐stage revision of infected TKA could achieve good outcomes.