The Use of a Novel On-bone Femoral Spacer Molding Device for Reducing Femoral Spacer Complications in Periprosthetic Total Knee Infection: Preliminary Results

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2024 May 22

PMID 38774406

Authors

Kulapat Chulsomlee

Eakkachai Warinsiriruk

Nutchanat Thongchuea

Nithid Sri-Utenchai

Sorawut Thamyongkit

Chavarat Jarungvittayakon

Siwadol Wongsak

Paphon Sa-Ngasoongsong

Satetha Vasaruchapong

Affiliations

Soon will be listed here.

Abstract

Background: The complications of mobile cement spacer are common. To address these issues, a novel on-bone femoral molding device (FMD) has been developed to enhance stability between the spacer-bone. This study investigated the clinical outcomes and complications associated with this novel FMD.

Methods: The FMD was developed using a reverse engineering program with the on-bone molding concept. Five knees of 4 patients were examined. The bone status, ambulatory ability, knee range of motion, and femoral spacer complications were followed up until 3 months after the second-stage surgery.

Results: The infection was successfully treated in all patients. The interim period was 21.6 ± 4.5 weeks. The range of motion measured before the first surgery, before the second surgery, and 3 months after the second surgery was 104.2 ± 43.1, 105.8 ± 20.0, and 124.0 ± 18.5 degrees, respectively. No femoral spacer complications were observed. One knee joint subluxation and 1 minor tibial spacer fracture occurred.

Conclusions: Newly developed FMD appears safe during initial proof-of-concept in patients with stage 1 to 2B bone loss. It prevents femoral spacer complications in a specific bone defect type without causing additional bone loss and facilitates range of motion during the interim period. Precise gap assessment and appropriate tibial cement spacer thickness could prevent knee dislocation.

References

Petis S, Perry K, Pagnano M, Berry D, Hanssen A, Abdel M . Retained Antibiotic Spacers After Total Hip and Knee Arthroplasty Resections: High Complication Rates. J Arthroplasty. 2017; 32(11):3510-3518. DOI: 10.1016/j.arth.2017.05.053. View

Parvizi J, Tan T, Goswami K, Higuera C, Della Valle C, Chen A . The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplasty. 2018; 33(5):1309-1314.e2. DOI: 10.1016/j.arth.2018.02.078. View

Struelens B, Claes S, Bellemans J . Spacer-related problems in two-stage revision knee arthroplasty. Acta Orthop Belg. 2013; 79(4):422-6. View

Lachiewicz P, Wellman S, Peterson J . Antibiotic Cement Spacers for Infected Total Knee Arthroplasties. J Am Acad Orthop Surg. 2019; 28(5):180-188. DOI: 10.5435/JAAOS-D-19-00332. View

Engh G, Ammeen D . Bone loss with revision total knee arthroplasty: defect classification and alternatives for reconstruction. Instr Course Lect. 1999; 48:167-75. View

Lin T, Tsai C, Fong Y, Shie M, Chen H, Chen Y . Posterior-Stabilized Antibiotic Cement Articulating Spacer With Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study. J Arthroplasty. 2022; 37(6):1180-1188.e2. DOI: 10.1016/j.arth.2022.01.094. View

Classen T, von Knoch M, Wernsmann M, Landgraeber S, Loer F, Jager M . Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision. Orthop Traumatol Surg Res. 2014; 100(4):409-12. DOI: 10.1016/j.otsr.2014.01.010. View

Parvizi J, Cavanaugh P, Diaz-Ledezma C . Periprosthetic knee infection: ten strategies that work. Knee Surg Relat Res. 2013; 25(4):155-64. PMC: 3867607. DOI: 10.5792/ksrr.2013.25.4.155. View

Warinsiriruk E, Thongchuea N, Pengrung N, Jarungvittayakon C, Sa-Ngasoongsong P, Chulsomlee K . Investigation of mechanical behavior on the cement hip spacer geometry under finite element method and compression load test. J Orthop. 2023; 47:115-121. PMC: 10687331. DOI: 10.1016/j.jor.2023.10.025. View

10.

Fei Z, Zhang Z, Wang Y, Zhang H, Xiang S . Comparing the Efficacy of Articulating Spacers in Two-Stage Revision for Periprosthetic Joint Infection Following Total Knee Arthroplasty: All-Cement Spacers vs Sterilized Replanted Metal-Polyethylene Spacers. Int J Gen Med. 2022; 15:3293-3301. PMC: 8959870. DOI: 10.2147/IJGM.S354808. View

11.

Haddad F, Masri B, Campbell D, McGraw R, Beauchamp C, Duncan C . The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br. 2000; 82(6):807-12. DOI: 10.1302/0301-620x.82b6.10486. View

12.

Cai Y, Fang X, Huang C, Li Z, Huang Z, Zhang C . Destination Joint Spacers: A Similar Infection-Relief Rate But Higher Complication Rate Compared with Two-Stage Revision. Orthop Surg. 2021; 13(3):884-891. PMC: 8126900. DOI: 10.1111/os.12996. View

13.

Tian M, Yang X, Tian X, Sun Y, Duan Y, Sun L . Short-term Follow-up of Antibiotic-loaded Articulating Cement Spacers in Two-stage Revision of Infected Total Knee Arthroplasty: A Case Series. Orthop Surg. 2018; 10(2):128-133. PMC: 6594512. DOI: 10.1111/os.12381. View

14.

Anderson J, Sculco P, Heitkemper S, Mayman D, Bostrom M, Sculco T . An articulating spacer to treat and mobilize patients with infected total knee arthroplasty. J Arthroplasty. 2008; 24(4):631-5. DOI: 10.1016/j.arth.2008.04.003. View

15.

Lyons S, Downes K, Habeck J, Whitham Z, Werger M, Stanat S . Early to midterm results of "low-friction" articulating antibiotic spacers for septic total knee arthroplasty. Arthroplast Today. 2019; 5(2):221-225. PMC: 6588818. DOI: 10.1016/j.artd.2019.03.004. View