title: The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement.
abstract: The PROSTALAC functional spacer is made of antibiotic-loaded acrylic cement but has a small metal-on-polythene articular surface. We have used it as an interim spacer in two-stage exchange arthroplasty for infected total knee replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the knee and a reasonable range of movement. It also helps to maintain the soft-tissue planes, which facilitates the second-stage procedure. We reviewed 45 consecutive patients, treated over a period of nine years. The mean follow-up was for 48 months (20 to 112). At final review, there was no evidence of infection in 41 patients (91%); only one had a recurrent infection with the same organism. There was improvement in the Hospital for Special Surgery knee score between stages and at final review. The range of movement was maintained between stages. Complications were primarily related to the extensor mechanism and stability of the knee between stages. Both of these problems decreased with refinement of the design of the implant. The rate of cure of the infection in our patients was similar to that using other methods. Movement of the knee does not appear to hinder control of infection.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, Canada.
authors.forename: F S
authors.initials: FS
authors.lastname: Haddad
authors.forename: B A
authors.initials: BA
authors.lastname: Masri
authors.forename: D
authors.initials: D
authors.lastname: Campbell
authors.forename: R W
authors.initials: RW
authors.lastname: McGraw
authors.forename: C P
authors.initials: CP
authors.lastname: Beauchamp
authors.forename: C P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D001424:Bacterial Infections / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D001843:Bone Cements / Q000627:therapeutic use*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000627:therapeutic use*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation / Q000601:surgery*; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D019904:Polymethyl Methacrylate