Real-component, all-cement articulating spacers clear prosthetic infection equally well
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SAN DIEGO — A study designed to determine the optimal articulating knee spacer for two-stage exchange in prosthetic joint infection cases showed similar efficacy and range of motion for two types of spacers studied, a presenter said.
At the American Academy of Orthopaedic Surgeons Annual Meeting, Jenna A. Bernstein, MD, presented results of a retrospective observational study based on cases that involved total knee arthroplasty articulating spacers used for first-time prosthetic joint infection (PJI) performed between June 2011 and June 2019 and were contained in the NYU Langone orthopedic database.
Among the 69 patients studied, 36 patients received a “real-component spacer made of total joint components and cemented into place with a porous cement technique and very high dose antibiotics,” Bernstein said. In addition, 33 patients studied received a premolded all-cement spacer.
“Importantly, all-cement articulating spacers and real-component spacers had similar efficacy in eradicating infection, and this was shown by the lack of significant difference in need for reoperation due to infection or diagnosis of reinfection made by the treating surgeon,” Bernstein said.
“The real-component group actually had significant fewer reoperations following the stage-one procedure overall,” she said.
Patients with either type of articulating spacer showed no differences in knee range of motion or arc of motion from the time of infection to postoperative follow-up after the second-stage surgery was completed, Bernstein said.
According to the abstract, there were statistically higher rates of revision surgery performed between the first and second stages in the all-cement spacer group (18.18%) vs. the real-component spacer group (0%).
Other findings of note were the real-component group, on average, was older than the all-cement group.
Further, the real-component group had a shorter length of stay and were more likely to be discharged to home after either one-stage and two-stage procedures, and these were both statistically significant differences, per the abstract.
“This study shows that real-component spacers were associated with equally good infectious clearance compared with cement articulating spacers and may overall actually decrease the number of operations for these patients,” Bernstein said.
Perspective
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Management between stages of a two-stage exchange for periprosthetic joint infection of the knee can be challenging with several different options available. Two of the most commonly used spacers are all-cement spacers made from prefabricated molds or the use of a primary femoral component and a polyethylene spacer that are “loosely” cemented into place.
In the retrospective study Jenna A. Bernstein, MD, and colleagues conducted, they compared these two methodologies and determined that the use of primary components is associated with a lower reoperation rate between stages and, after the second-stage exchange, is associated with no difference in successful eradication of infection. The results of this study can allay some of the fears around the use of primary components where metal and plastic are utilized. However, they also suggest that potentially a one-stage exchange may work just as well without the need for a second operation.
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Bernstein JA, et al. Paper 1. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31-Sept. 3, 2021; San Diego.
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