Complications associated with 133 static, antibiotic-laden spacers after TKA.

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Biomaterials in Arthroplasty

Background:

• Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a significant complication.
• Two-stage revision arthroplasty with an antibiotic-laden cement spacer is the established treatment for chronic PJI.
• Limited data exists on mechanical complications during this two-stage revision process.

Purpose of the Study:

• To determine the incidence and types of mechanical complications during two-stage revision for infected TKA.
• To identify factors influencing these mechanical complications and overall treatment outcomes.

Main Methods:

• A retrospective analysis of 133 patients undergoing two-stage TKA revision between 2000 and 2011.
• Recording of mechanical complications including fractures, spacer issues, patellar subluxation, nerve involvement, and wound healing disorders.
• Analysis of potential influencing factors such as BMI, ASA classification, and prior revision history.

Main Results:

• 15% of patients (20 out of 133) experienced mechanical complications.
• The most common complications were tibial fracture/fissure (6.8%) and femoral fracture/fissure (2.3%).
• Revisions after reimplantation (reinfection) and after explantation (reinfection) were significant factors influencing outcomes.

Conclusions:

• Two-stage revision arthroplasty with a static cement spacer is a viable and effective treatment for infected TKAs.
• The observed 15% complication rate, including range of motion limitations, is considered acceptable.
• Minimizing complications related to subsequent revisions is crucial for successful two-stage TKA protocols.