Molded Articulating Cement Spacers for Two-Stage Treatment of Infected THA and TKA

Articulating spacers have been reported to promote greater range of motion, preserve bone, facilitate reimplantation, and enhance functional recovery, as well as provide a vehicle for local administration of antibiotics. The purpose of this study was to review patients treated at our center for deep hip and knee infection with two-staged exchange using molded, articulating antibiotic-laden cement spacers following debridement. A query of our practice registry revealed 84 patients (84 hips) and 177 patients (182 knees) diagnosed with deep infection after THA and TKA respectively, and treated with two-staged exchange using molded articulating cement spacers. Mean follow-up was three years in both groups. Second-stage reimplantation was accomplished in 81 hips, and reinfection occurred in 11 of those (14%), with three responding to a single irrigation and debridement (I&D) procedure, one undergoing two I&Ds, one chronically infected diabetic patient treated with one-stage exchange to cemented components, five patients undergoing multiple procedures including repeat two-staged exchange in four, and one patient declining further treatment. Harris hip score at most recent averaged 69. Second-stage reimplantation was accomplished in 177 knees, and reinfection occurred in 28 of those (16%). Range of motion improved from 93° preoperatively to 101° at most recent, Knee Society clinical scores improved from 46 to 76, and functional scores improved from 32 to 47. Treatment of deep infection after total joint arthroplasty using molded, articulating antibiotic-laden acrylic cement spacers was successful in eradicating infection in 83% of hips (70 of 84) and 82% of knees (149 of 182) at an average of three years after reimplantation.