title: Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer.
abstract: BACKGROUND
  Two-stage exchange arthroplasty remains the standard treatment of infection at the site of a total knee arthroplasty. The clinical and functional outcomes associated with the use of an articulating antibiotic spacer for two-stage revision for infection are not well established. We conducted a retrospective study to evaluate the outcomes associated with the use of the PROSTALAC articulating spacer between the first and second stages.
  
  
  METHODS
  Fifty-eight patients underwent two-stage revision total knee arthroplasty for infection between January 1997 and December 1999. Of these, fifty-four were alive at the time of follow-up and forty-seven were available for inclusion in the present retrospective study. In all patients, a prosthesis of antibiotic-loaded acrylic cement (the PROSTALAC system) was implanted during the first stage after débridement. The amount of osteolysis that occurred between the stages and the range of motion of the knee joint were measured. After two years of follow-up, outcomes were assessed with use of the WOMAC, Oxford-12, and SF-12 instruments as well as a satisfaction questionnaire.
  
  
  RESULTS
  At a minimum of two years (average, forty-one months) after revision arthroplasty, two patients (4%) had had a recurrence of infection. The amount of bone loss was unchanged between stages, and the range of movement of the knee improved from 78.2 degrees before the first stage to 87.1 degrees at two years. The average normalized WOMAC function and pain scores were 68.9 and 77.1, respectively; the average Oxford-12 score was 67.3; the average SF-12 mental and physical scores were 53.7 and 41.2, respectively; and the average satisfaction score was 71.7.
  
  
  CONCLUSIONS
  A revision operation for infection at the site of a total knee replacement with use of an articulating spacer was associated with reasonable function and satisfaction scores. These findings may be related to the articulating features of the PROSTALAC system, which permits full active movement of the knee in the early postoperative period.
authors.affiliation: Department of Orthopaedics, Vancouver Hospital and Health Sciences Center, The University of British Columbia, Vancouver, Canada.
authors.forename: R M Dominic
authors.initials: RM
authors.lastname: Meek
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
authors.forename: David
authors.initials: D
authors.lastname: Dunlop
authors.forename: Donald S
authors.initials: DS
authors.lastname: Garbuz
authors.forename: Nelson V
authors.initials: NV
authors.lastname: Greidanus
authors.forename: Robert
authors.initials: R
authors.lastname: McGraw
authors.forename: Clive P
authors.initials: CP
authors.lastname: Duncan
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019645:Arthroplasty, Replacement, Knee; D016503:Drug Delivery Systems / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D017060:Patient Satisfaction; D020127:Recovery of Function / Q000502:physiology*; D012086:Reoperation; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents