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.
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
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