title: Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision.
abstract: BACKGROUND
  Deep periprosthetic infection is one of the most serious complications after total knee replacement. The two-stage procedure with implantation of a temporary cement spacer and later re-implantation of a revision total knee prosthesis is an accepted procedural standard. The use of articulating spacers has been proposed to enhance ease of revision and functional results.
  
  
  METHODS
  Twenty-three patients treated with an articulating spacer were retrospectively studied. All patients had undergone a two-stage surgery. The infected prosthesis was explanted and the femoral component was sterilized and re-implanted. On the tibial side a block of gentamicin-loaded bone cement was produced intraoperatively using specially manufactured templates. Eighteen total knee arthroplasty revisions and 5 arthrodesis were finally performed.
  
  
  RESULTS
  A total of three (13%) re-infections occurred 5-20 months after revision total knee arthroplasty in a mean follow-up period of 47 months. Prior to re-implantation, flexion with the articulating spacer ranged between 15 and 100° (mean 68±28°). The average postoperative flexion after re-implantation of total knee replacement was 105±11°.
  
  
  CONCLUSIONS
  The articulating spacer used in this study appears to be as effective as the standard procedures in terms of re-infection risk rate and postoperative range of motion recovery.
  
  
  METHODS
  Level IV.
authors.affiliation: Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany. Electronic address: timclassen@gmx.de.
authors.forename: T
authors.initials: T
authors.lastname: Classen
authors.affiliation: Orthopaedic Department, Hospital of Bremerhaven, Bremerhaven, Germany.
authors.forename: M
authors.initials: M
authors.lastname: von Knoch
authors.affiliation: Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Wernsmann
authors.affiliation: Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Landgraeber
authors.affiliation: Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Löer
authors.affiliation: Orthopaedic Department, University of Duisburg - Essen Medical School, Hufelandstrasse 55, 45147 Essen, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Jäger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: Articulating spacer; Infection; Knee; Total knee arthroplasty; Two-stage revision