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Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint infection

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Two-stage exchange arthroplasty is considered the gold standard for treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Antibiotic cement spacers can include cement-based spacers (CBS), new components (NEW), and autoclaved components (ACL). The factors that most influence post-reimplantation prosthesis (PRP) survival were determined.

Methods

A retrospective database review of patients undergoing two-stage exchange arthroplasty from 2008 to 2014 was performed. There were 85 patients, 25 patients and 30 patients in CBS, NEW and ACL groups, respectively. Patient, disease and surgical characteristics were collected and analyzed. Post-reimplantation prosthesis (PRP) survival was modeled using the Kaplan–Meier method. Cox proportional hazard modeling was then performed to identify risk factors associated with implant failure.

Results

Overall PRP survival was 82% in 140 unilateral TKAs. PRP survival between groups was 81%, 96% and 73% within the minimum 2-year follow-up period, respectively. There was a difference in median interval-to-reimplantation between groups (CBS, 72.0 days; NEW, 111.0 days; ACL, 84.0 days, p = 0.003). Adjusting for time-to-reimplantation, NEW spacers demonstrated greater PRP survival compared with ACL spacers (p = 0.044), and a trend towards greater survival compared with CBS spacers (p = 0.086). Excluding early failures (< 90 days), NEW spacers still demonstrated greater survival than ACL spacers (p = 0.046). Lower volume (≤ 10 within this series) surgeons tended to use more CBS spacers, while higher volume surgeons were comfortable with ACL spacers.

Conclusions

There was greater PRP survival with NEW spacers. NEW spacers also demonstrated an increased inter-stage interval, likely because of increased comfort and motion. There were spacer choice differences between low- and high-volume surgeons.

Level of evidence

III.

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Authors and Affiliations

  1. Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Colin Y. L. Woon & Geoffrey Westrich

  2. Biostatistics Core, Hospital for Special Surgery, New York, USA

    Joseph Nguyen

  3. Infectious Disease Service, Hospital for Special Surgery, New York, USA

    Milan Kapadia, Celeste A. Russell, Michael Henry & Andy Miller

Authors
  1. Colin Y. L. Woon
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  2. Joseph Nguyen
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Correspondence to Colin Y. L. Woon.

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Conflict of interest

CYW, JN, MK, CAR, MH and AM have no conflicts of interest. GW receives consultancy payments and research support from Stryker Orthopaedics and Exactech, Inc. GW is a member of the speakers bureau of Mallinckrodt Pharmaceuticals and receives payment for presentations.

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Woon, C.Y.L., Nguyen, J., Kapadia, M. et al. Temporary new implant spacers increase post-reimplantation total knee prosthesis survival after periprosthetic joint infection. Knee Surg Sports Traumatol Arthrosc 29, 3621–3632 (2021). https://doi.org/10.1007/s00167-020-06325-6

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  • DOI: https://doi.org/10.1007/s00167-020-06325-6

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