Use of Articulating Spacer Technique in Revision Total Knee Arthroplasty Complicated by Sepsis: A Systematic Meta-Analysis

Periprosthetic infection after total knee arthroplasty is a devastating complication, and 2-stage exchange is the standard of care in North America. Articulating spacers are effective in treating periprosthetic joint infections, but the optimal articulating spacer construct has yet to be identified. The authors performed a systematic review using MEDLINE, MEDLINE In-Process, EMBASE, BIOSIS, ClinicalTrials.gov, and Cochrane Database of Systematic Reviews. They identified 34 articles meeting inclusion criteria, producing 1016 spacers for comparison. Metal-on-polyethylene spacers had a statistically significant increased interim range of motion compared with other spacers (P<.003). No statistical differences regarding reinfection rates existed among the 4 types of articulating spacers (P<.68). Difficulty of reimplantation was similar between groups (P<.10). There were fewer spacer-specific complications with the metal on polyethylene compared with the other groups (P<.043) and no spacer fractures. This study answers several clinically relevant questions and provides useful information in guiding clinical decision making in treating periprosthetic infections after total knee arthroplasty. [Orthopedics. 2017; 40(4):212-220.].