Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 5 Issue 9

Midterm Results of 2 Stage Revision for Periprosthetic Knee Infection. Comparison of Metal/Polyethylene and Metal/Cement Types of Spacers

Denis Vladimirovich Rimashevskiy1*, Ildar Fuatovich Ahtyamov2, Erkin Dauir Kurmangalyev3, Stanislav Vladimirovich Rangaev3, Alexey Alexandrovich Belokobylov4, Dan Zhadygerov5, Bulat Iskakov6, Marat Khudayergenov7, Manarbek Aubakirov8 and Reinhard Schnettler9

1Peoples Friendship University of Russia, Moscow, Russia

2Kazan State Medical University, Kazan, Russia

3Makazhanov’s Area Trauma and Orthopedics Center, Karaganda, Kazakhstan

4Trauma and Orthopedics Inst, Nur-Sultan, Kazakhstan

5National Research Oncology Center, Nur-Sultan, Kazakhstan

6Medical Center Hospital of President’s Affairs, Nur-Sultan, Kazakhstan

7Citymed Medical Center, Shymkent, Kazakhstan

84th City Clinical Hospital, Almaty, Kazakhstan

9Justus Liebig University, Giessen, Germany

*Corresponding Author: Denis Vladimirovich Rimashevskiy, Peoples friendship University of Russia, Moscow, Russia.

Received: May 16, 2022; Published: August 17, 2022


Background: Two stage revision for periprosthetic joint infection after total knee arthroplasty is the golden standard of treatment, but it has a large number of reinfections and outcomes of re-implantations are far from optimal. Many patients after spacer implantation are not being reimplanted during the first 6 months due to multiple reasons.

Method: In this prospective study 160 patients (160 joints) who underwent two stage revision for septic knee arthroplasty were included. In all cases articulating spacers with primary metal femoral component and armed intramedullary spacers (dowels) were implanted. 4 patients were lost to follow-up within a year after the spacer implantation with confirmed infection sedation at the first follow up in 3 months after spacer implantation and were excluded from the study. Out of the rest 156 cases in 81 case liner of bone cement was used. In 75 cases we used polyethylene liner. Medical comorbidities, type of knee replacement (primary vs. revision), culture results, serum hemoglobin level, erythrocyte sedimentation rate, Knee Society Score, knee range of motion, were all recorded before the first spacer implantation, in 3 months and at the last follow-up in average 56.35±18.77 months after reimplantation or spacer with poly liner implantation.

Results: After the first stage infection relapsed in 33% (N = 27) of the cases in cement liner group and in 8% (N = 6: 4 during the first 6 months after the 1st spacer implantation and 2 later) of cases in poly liner group. At the last follow-up control over infection with functioning articulating knee was achieved in 85% and 94.7% of cases, respectively. Clinical and functional results in poly liner group were significantly better than in cement liner group at all periods of follow-up (p ≤ 0,05).

Conclusion: superior results of poly liner spacers over cement liner spacers made us completely abandon cement liner spacer technique and broaden the indications for so called temporary-permanent spacers with polyethylene liner in cases of infection in the knee with possibility to achieve knee stability with non-constrained spacer. Success of temporary-permanent spacers implantation may lead us towards wider use of one stage revisions in “high risk” deep infection after knee arthroplasty.


Keywords: Knee; Complications; Infection; Spacer; Flap


  1. Boylan MR., et al. “The mortality of periprosthetic infection”. AAOS (2017): P056.
  2. Akindolire J., et al. “The Economic Impact of Periprosthetic Infection in Total Hip Arthroplasty”. P0009 - 2018 [Board P0009] AAOS View ePoster Adult Reconstruction Hip Poster Session I Presented on (2018): 7.
  3. Sousa A., et al. “Economic Impact of Prosthetic Joint Infection - an Evaluation Within the Portuguese National Health System”. Journal of Bone and Joint Infection 4 (2018): 197-202.
  4. Rosteius T., et al. “Evaluating the microbial pattern of periprosthetic joint infections of the hip and knee”. Journal of Medical Microbiology 11 (2018): 1608-1613.
  5. Benito N., et al. “Etiology of surgical site infections after primary total joint arthroplasties”. Journal of Orthopaedic Research 32 (2014): 633-637.
  6. Weston JT., et al. “Irrigation and debridement with chronic antibiotic suppression for the management of infected total knee arthroplasty”. The Bone and Joint Journal 11 (2018): 1471-1476.
  7. Dilworth B., et al. “Risk of reinfection after irrigation and debridement for treatment of acute periprosthetic joint infection following total knee arthroplasty”. Journal of Knee Surgery (2017): 7.
  8. Walkay S., et al. “Debridement, antibiotics, irrigation and retention of prosthesis (DAIR) for infected primary hip and knee arthroplasty - experience from a dedicated high volume arthroplasty unit”. EFORT 2018, #3017 Orthopaedics - Clinical Study/Free Papers/Knee and Lower Leg/Joint Replacement-Primary.
  9. Gallo J., et al. “Comparison of therapeutic strategies for hip and knee prosthetic joint infection”. Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca 76 (2009): 302e9.
  10. Clement N., et al. “Should single- or two-stage revision surgery be used for the management of an infected total knee replacement? A critical review of the literature”. OA Orthopaedics 1 (2013): 2.
  11. Murylev VY., et al. “Application of spacers for hip and knee PJI treatment”. Vestnik travmatologii i ortopedii im. N.N. Priorova 3 (2013): 18-24.
  12. Kurmangalyev ED. “Primenenie originalnyh spejserov dlya pervogo etapa revizii kolennogo sustava (Original spacers for PJI after TKA) (Phd diss), Moscow (2018).
  13. Ermakov AM., et al. “Efficiency of two-stage revision arthroplasty in management of periprosthetic knee and hip joint infection”. Genij Ortopedii3 (2018): 321-326.
  14. Kliushin NM., et al. “Our experience in the management of periprosthetic knee joint infection”. Genij Ortopedii2 (2019): 162-171.
  15. Wang Q., et al. “Two-Stage Exchange Arthroplasty for Periprosthetic Joint Infection: The Rate and Reason for the Attrition After the First Stage”. The Journal of Arthroplasty S0883-5403.19 (2019)30591.
  16. Fleischman AN., et al. “Mechanical Complications Following Total Hip Arthroplasty Based on Surgical Approach: A Large, Single-Institution Cohort Study”. The Journal of Arthroplasty 6 (2019): 1255-1260.
  17. Tan TL., et al. “Determining the Role and Duration of the "Antibiotic Holiday" Period in Periprosthetic Joint Infection”. The Journal of Arthroplasty 9 (2018): 2976-2980.
  18. Osmon DR., et al. “Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America”. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America (2012): 56.
  19. Belokobylov AA. “Hirurgicheskaya korrekciya vnutrisustavnyh perelomov proksimalnogo otdela bolshebercovoj kosti Kand”. diss [Surgical correction intraarticular proximal tibia fractures. Phd. diss], Astana (2008).
  20. Bozic KJ., et al. “The epidemiology of revision total knee arthroplasty in the United States”. Clinical Orthopaedics and Related Research 468 (2010): 45-51.
  21. Le DH., et al. “Current modes of failure in TKA: infection, instability, and stiffness predominate”. Clinical Orthopaedics and Related Research 472 (2014): 2197-2200.
  22. Schroer WC., et al. “Why are total knees failing today? Etiology of total knee revision in 2010 and 2011”. The Journal of Arthroplasty 28 (2013): 116-119.
  23. Sharkey PF., et al. “Why are total knee arthroplasties failing today–has anything changed after 10 years?” The Journal of Arthroplasty 29 (2014): 1774-1778.
  24. Hossain F., et al. “Two-stage revision using a modified articulating spacer in infected total knee arthroplasty”. Knee Surgery and Related Research 25 (2013): 180-185.
  25. Citak M., et al. Journal of Orthopaedic Research 1 (2014): S120–129.
  26. Castelli CC., et al. “Two-stage treatment of infected total knee arthroplasty: two-to-thirteen-year experience using an articulating preformed spacer”. International Orthopaedics 38 (2014): 405-412.
  27. Van Thiel GS., et al. “Intraoperative molds to create an articulating spacer for the infected knee arthroplasty”. Clinical Orthopaedics and Related Research 469 (2014): 994-1001.
  28. Johnson AJ., et al. “Minimizing dynamic knee spacer complications in infected revision arthroplasty”. Clinical Orthopaedics and Related Research 470 (2012): 220-227.
  29. Park YB., et al. “Antibiotic-impregnated articulating cement spacer maintained for 7 years in situ for two-stage primary total knee arthroplasty: a case report”. BMC Musculoskeletal Disorders1 (2019): 179.
  30. Hicks CA., et al. “The anatomy of the tibial intramedullary canal”. Clinical Orthopaedics and Related Research 321 (1995): 111-116.
  31. Abraham R., et al. “An anatomical study of tibial metaphyseal/diaphyseal mismatch during revision total knee arthroplasty”. The Journal of Arthroplasty 2 (2007): 241- 244.
  32. Goosen JHM and Van Hellemondt GG. “Tibial component offset in revision total knee arthroplasty”. In: Rossi R, Bonasia DE, editors. Total Knee Revision Surgical Techniques. Edizioni Minerva Medica (2013).
  33. Jun F., et al. “The proper timing of second-stage revision in treating periprosthetic knee infection: reliable indicators and risk factors”. Journal of Orthopaedic Surgery and Research 13 (2018): 214.
  34. Preobrazhensky PM., et al. “Results of two-stage reimplantation in patients with periprosthetic joint infection after total knee arthroplasty”. Traumatology and Orthopedics of Russia1 (2017): 98-107.
  35. Pavlov VV., et al. “Two-Stage Treatment of Periprosthetic Infection: Mid-Term Results”. Traumatology and Orthopedics of Russia 4 (2019): 109-116.
  36. Prohorenko VM., et al. “Sovremennye problemy nauki i obrazovaniya 6 (2015).


Citation: Denis Vladimirovich Rimashevskiy., et al. “Midterm Results of 2 Stage Revision for Periprosthetic Knee Infection. Comparison of Metal/Polyethylene and Metal/Cement Types of Spacers". Acta Scientific Orthopaedics 5.9 (2022): 69-79.


Copyright: © 2022 Denis Vladimirovich Rimashevskiy., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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