Two-stage approach using articulating antibiotic-loaded spacers is beneficial to treat septic arthritic knees

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Created On: 28/08/2020

Two-stage approach using articulating antibiotic-loaded spacers is beneficial to treat septic arthritic knees

A retrospective study was conducted to explore the efficacy of a two-stage approach using a homemade metal-on-plastic articulating spacer in patients with advanced knee arthritis and joint infection.

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Key take away

The study investigating a two-stage approach using an articulating spacer for the management of infected arthritic knees after failed eradication surgery in 16 patients depicted that the technique was effective in all patients. The septic arthritic infection was effectively eliminated.

Background

Method

From 2006 to 2016, the study recruited a total of 16 consecutive patients with advanced osteoarthritis and knee infection. The subjects were followed-up for a mean time of 6.1 years. For the elimination of infection, all the subjects had previously undergone one or more failed arthroscopic or open procedures. The same homemade articulating antibiotic spacer was given to all the subjects presented in Figure below..

Figure: After radical debridement, the articulating metal-on-plastic spacer (a) was created using a femoral prosthesis component and a posterior-stabilized polyethylene insert (NexGen Legacy PosteriorStabilized Knee LPS, Zimmer, Warsaw, USA) and antibiotic-loaded cement (1 g gentamicin+1 g clindamycin per 40 g cement) (b). The spacer provides an excellent range of motion and a high local dose of antibiotics in the joint

Double antibiotic therapy was administered for two weeks intravenously and orally for 4 weeks. TKA implantation was conducted six weeks after the first stage.

Result

In all patients, the infection was effectively eliminated without any recurrence. The values for mean knee flexion, mean KSS (Knee Society Score) objective, mean KSS function, mean VAS (visual analogue scale) score preoperatively, after TKA implantation, and after spacer implantation are illustrated in the following table:

Significant improvements were witnessed in functional results. The pain was considerably diminished after spacer and TKA implantation.

Conclusion

In patients with septic arthritic knees, a two-stage approach using articulating antibiotic-loaded spacers reduces pain, improves knee function, and eradicates infection.