title: Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.
abstract: Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The "SMILES spacer" was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24-70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation.
authors.affiliation: The Royal National Orthopaedic Hospital, Stanmore Middlesex HA7 4LP, United Kingdom. simonmacmull@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Macmull
authors.forename: W
authors.initials: W
authors.lastname: Bartlett
authors.forename: J
authors.initials: J
authors.lastname: Miles
authors.forename: G W
authors.initials: GW
authors.lastname: Blunn
authors.forename: R C
authors.initials: RC
authors.lastname: Pollock
authors.forename: R W J
authors.initials: RW
authors.lastname: Carrington
authors.forename: J A
authors.initials: JA
authors.lastname: Skinner
authors.forename: S R
authors.initials: SR
authors.lastname: Cannon
authors.forename: T W R
authors.initials: TW
authors.lastname: Briggs
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology / Q000601:surgery*; D019904:Polymethyl Methacrylate; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D055815:Young Adult
chemical_list: D019904:Polymethyl Methacrylate