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Articulating spacer may help avoid second-stage revision TKA

Single-stage revision with a modified articulating spacer yielded good function while retaining the option for second-stage surgery.

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Implanting an articulating spacer during revision for an infected total knee arthroplasty may provide patients with acceptable function and help avoid second-stage surgery, according to a study.

Allister Trezies, MBBS, FRCS(Orth), and colleagues in Sydney reviewed their results using a modified articulating spacer in 11 patients revised for an infected TKA. The study included seven men and four women with a mean age of 69.5 years at the time of spacer surgery.

The articulating spacer used had a standard cobalt chrome femoral component and a polyethylene tibial component without a metal base tray. All components were implanted with antibiotic-loaded cement (Palacos R, Zimmer), according to the study, published in The Journal of Arthroplasty.

In five patients, surgeons first performed an arthroscopic synovectomy before implanting the articulating spacer. A two-stage revision with a nonarticulating cement spacer was initially performed in two patients, but articulating spacer implantation was the initial procedure for the remaining four patients.

At a mean follow-up of 81.4 months, six of the 11 modified spacers remained in situ, "with no evidence of recurrent infection, and the patients were keen to avoid any further surgery," the study authors said. Patients had a mean Knee Society score of 167, ranging from 115 to 193, they noted.

During follow-up, two patients died with the implants still in place. One patient underwent a second-stage revision due to recurrent infection, and two patients were revised for pain, according to the study.

"It was seen that a number of patients ... showed signs that their infection had resolved with one-stage surgery and they had very acceptable function and symptom relief. As the prosthesis inserted used definitive products, there was no compulsion to undertake an immediate second-stage procedure," the study authors said.

"Many patients still retain their implants and demonstrate reasonable function scores; should they become symptomatic, however, then the option still exists to revise to a definitive prosthesis," they said.

For more information:

• Trezies A, Parish E, Dixon P, Cross M. The use of an articulating spacer in the management of infected total knee arthroplasty. J Arthroplasty. 2006;21:702-704.