title: Articulated spacer provides long-term knee improvement after two-stage reimplantation.
abstract: OBJECTIVE
  The purpose of this study was to determine the long-term outcome in patients who underwent two-stage reimplantation with an articulated spacer following a chronic periprosthetic knee infection. The hypothesis was that the use of an articulated spacer provides significant improvement of clinical results and knee functionality through a long follow-up period, and therefore a durable revision TKA.
  
  
  METHODS
  Forty-six consecutive patients (46 knees) who underwent two-stage reimplantation with an articulated spacer for a chronic periprosthetic knee infection were retrospectively analysed. An articulated cement spacer, moulded in surgery room, was implanted in all cases. Patients were followed for a median period of 12 (range 6-16) years, and no patients were lost to follow-up. Patients were assessed preoperatively and postoperatively through the IKS knee and function scores and ROM.
  
  
  RESULTS
  Two-stage reimplantation was successful in controlling the infection in 91.3 % of patients. In the 42 patients with a successful two-stage revision, the median IKS knee and function scores were 36 (range 16-56) points and 25 (range 15-35) points, respectively, before the operation, and 76 (range 52-94) points and 70 (range 55-90) points (p < 0.001) at the last follow-up. The median ROM increased from 80 (range 60-110) degrees preoperatively to 115 (range 100-128) degrees (p < 0.01) at the last follow-up.
  
  
  CONCLUSIONS
  Two-stage septic revision with an articulated cement spacer provided a significant long-term improvement of preoperative clinical and functional knee scores and therefore a durable revision TKA.
  
  
  METHODS
  Retrospective case series, Level IV.
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy. vassomichele@gmail.com.
authors.forename: Michele
authors.identifier: http://orcid.org/0000-0003-2559-3714
authors.initials: M
authors.lastname: Vasso
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Del Regno
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Corona
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: D'Apolito
authors.affiliation: Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis, 86100, Campobasso, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Schiavone Panni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements
keywords: Articulated spacer; Failure; Infection; Total knee arthroplasty; Two-stage reimplantation