title: Is there a preferred articulating spacer technique for infected knee arthroplasty? A preliminary study.
abstract: BACKGROUND
  Periprosthetic infection in TKA is a devastating and challenging problem for both patients and surgeons. Two-stage exchange arthroplasty with an interval antibiotic spacer reportedly has the highest infection control rate. Studies comparing static spacers with articulating spacers have reported varying ROM after reimplant, which could be due to differences in articulating spacer technique.
  
  
  OBJECTIVE
  We therefore determined whether one of three articulating spacer techniques was superior in terms of (1) infection control, (2) final ROM, and (3) cost.
  
  
  METHODS
  We retrospectively reviewed 53 patients with infected TKAs who had two-stage exchange arthroplasty with one of three techniques with articulating spacers: autoclaving an original component (n = 15), a new femoral component (n = 16), and a silicone mold component (n = 22). We compared infection control, ROM, and cost. Minimum followup was 12 months (mean, 39 months; range, 12-105 months).
  
  
  RESULTS
  We found no difference in infection control among the three techniques. Infection control was achieved in 13 of 15 (86.7%) autoclaved original component spacers at mean 73 months (range, 37-105 months), 15 of 16 (93.8%) new femoral component spacers at mean 19 months (range, 12-32 months), and 20 of 22 (90.9%) silicone mold component spacers at mean 32 months (range, 14-56 months). Mean final flexion was 95.7°, 98.3°, and 93.8°, respectively. Direct costs for all implants, molds, cement, and antibiotics were $932, $3589, and $3945, respectively.
  
  
  CONCLUSIONS
  We found comparable infection control and ROM for the three techniques. Direct cost was least for the autoclaved original component technique.
authors.affiliation: Department of Orthopaedic Surgery, University of Minnesota Medical School, Minneapolis VAMC Section 112E, 1 Veterans Drive, Minneapolis, MN 55417, USA.
authors.forename: Niraj V
authors.initials: NV
authors.lastname: Kalore
authors.forename: Aditya
authors.initials: A
authors.lastname: Maheshwari
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.forename: Edward
authors.initials: E
authors.lastname: Cheng
authors.forename: Terence J
authors.initials: TJ
authors.lastname: Gioe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome