title: Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty.
abstract: BACKGROUND
  The result of treatment of infections involving antibiotic-resistant organisms in total knee arthroplasty (TKA) is often poor. We evaluated the efficacy of 2-stage revision in TKAs infected with resistant organisms and compared the clinical outcomes with articulating and conventional static spacers, in terms of both infection control and function.
  
  
  METHODS
  In a prospective manner, from June 2003 to January 2007 selected patients with a TKA infected with resistant organisms were enrolled and treated with 2-stage re-implantation. The 45 patients were divided into 2 groups: group A (23 patients) implanted with the articulating spacers and group S (22 patients) implanted with static spacers. All patients followed the same antibiotic protocols and had the same re-implantation criteria. The efficacy of infection control was evaluated using re-implantation rate, recurrence rate, and overall success rate. The functional and radiographic results were interpreted with the Hospital of Special Surgery (HSS) knee score and the Insall-Salvati ratio.
  
  
  RESULTS
  With mean 40 (24-61) months of follow-up, 22 of 23 knees were re-implanted in group A and 21 of 22 were re-implanted in group S. Of these re-implanted prostheses, 1 re-infection occurred in group A and 2 occurred in group S. Range of motion after re-implantation, the final functional scores, and the satisfaction rate were better in group A. One third of the patients in group S, and none in group A, had a patella baja.
  
  
  CONCLUSIONS
  After 2-stage re-implantation of TKAs originally infected with resistant organisms, the clinical outcome was satisfactory-and similar to that reported after treatment of TKAs infected with low-virulence strains. Treatment with an articulating spacer resulted in better functional outcome and lower incidence of patella baja.
authors: Department of Orthopaedics and Traumatology, Veterans General Hospital, Taipei, Taiwan.
authors: En-Rung
authors: ER
authors: Chiang
authors: Yu-Ping
authors: YP
authors: Su
authors: Tain-Hsiung
authors: TH
authors: Chen
authors: Fang-Yao
authors: FY
authors: Chiu
authors: Wei-Ming
authors: WM
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D003030:Coagulase; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects; D008297:Male; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000209:etiology; D013210:Staphylococcus / Q000201:enzymology; D016896:Treatment Outcome; D014640:Vancomycin / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D003030:Coagulase; D014640:Vancomycin