Two-stage total infected knee arthroplasty treatment with articulating cement spacer.

Introduction: The treatment of infected total knee arthroplasty (TKA) is controversial and various. Two-stage prolonged reimplantation and 6-week systemic antibiotics use have been a gold standard of treatment in recent years.

Patients: Seventeen knees of 17 patients, who underwent primary TKA and subsequently developed infections, were implanted articulating antibiotic-loaded cement spacer through two-stage reimplantation. In the postoperative period, parenteral antibiotic treatment targeting the specific microorganism detected in each patient was started and continued with oral administration. The mean total (parenteral and oral) antibiotic treatment time was 6.8 weeks (6-10). The spacer remained in its location until complete soft tissue recovery and normal values for laboratory parameters were achieved. The mean time interval between spacer implantation and reimplantation was 4.2 months (3-6).

Results: In the last follow-up examinations of the patients, conditions requiring reoperation were detected in 3 patients (17.6%). In 2 of these patients (11.7%), infection developed after a mean 1-year interval. The joint motion ranges of the patients were measured in the preoperative period, during spacer use, and following reimplantation. The mean joint motion range of the patients was 58 degrees (12-90) in the preoperative period; in the presence of spacer between the two stages, 69 degrees (15-100); and in the last follow-up examination after reimplantation, 95 degrees (10-120).

Conclusion: Use of articulating cement spacer in the treatment of infected TKA is efficient and reliable.