title: Intraoperatively-made cement-on-cement antibiotic-loaded articulating spacer for infected total knee arthroplasty.
abstract: Cement articulating spacers have been used for the treatment of TKA infection. The disadvantages of commercially available pre-made mobile spacers include limitations in implant size and antibiotic dose, often allowing delivery of only a single antibiotic agent. Hand-made mobile spacers fail to provide a well-shaped and congruently articular surface and have difficulties in maintaining stability. We present a method of intraoperatively-made cement-on-cement antibiotic-loaded articulating spacer for infected total knee arthroplasty. A custom mold was made intraoperatively with bone cement and the standard posterior stabilized TKA provisional components which were of the same size as the original prosthesis. Fabrication of the spacers did not increase the overall surgical time. From 2004 to 2007, 17 infected total knee arthroplasties were treated with two-stage reimplantation. The average length of follow-up was 31 months. One patient required an above-knee amputation for persistent infection. A knee arthrodesis was performed in one case. Ten patients received reimplantation with Nexgen LCCK knee implants. Articulating spacers were retained in situ in five patients. This articulating spacer can help improve knee mobility and function during the interval between stages.
authors.affiliation: Department of Orthopedic Surgery, Division of Joint Replacement Surgery, Shanghai No 6th people's Hospital, Shanghai Jiaotong University, Shanghai 200233, PR China.
authors.forename: Hao
authors.initials: H
authors.lastname: Shen
authors.forename: Xianlong
authors.initials: X
authors.lastname: Zhang
authors.forename: Yao
authors.initials: Y
authors.lastname: Jiang
authors.forename: Qiaojie
authors.initials: Q
authors.lastname: Wang
authors.forename: Yunsu
authors.initials: Y
authors.lastname: Chen
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Junjie
authors.initials: J
authors.lastname: Shao
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D001843:Bone Cements; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000502:physiology / Q000601:surgery; D007720:Knee Prosthesis; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D011859:Radiography; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012086:Reoperation
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements