Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: Good outcome in 30 patients

Figures & data

Figure 1. The grooves, the central crest on the tibial component, and the trochlear groove on the femoral component can be seen. This shape of the spacer increases conformity and reduces instability.

Figure 2. Remodeling of posterior condyles with a curved osteotome.

Figure 3. Remodeling of the throclear groove with the highspeed burr.

Figure 4. Flexion over 90° in the same patient (A) and over 75° in another case (B).

Cases of infected knee arthroplasties

Diagnosis, age, sex ^a	Primary TKA ^b	Microorganism ^c / antibiotics	Time to infection	ROM with spacer	Knee exposure ^d	Revision prosthesis	ROM ^d	KSS score follow-up	R ^e
OA 77 F	Profix (S&N)	MRSA, Enterobacteriae/rifampicin + cotrimoxazole	6 weeks	0–75°	9 weeks Q snip	Profix (S&N)	0–90°	68/60 3 years	F
OA 82 M	IB II (Zimmer)	Streptococcus viridans/ceftriaxone + cotrimoxazole	1.5 years	0–85°	10 weeks	IB-CCK (Zimmer)	5–110° IR	95/85 5 years	E
RA 68 F	IB II (Zimmer)	MSSA/ cefazolin + ciprofioxacin	1.5 years	0–90°	11 weeks	IB-CCK (Zimmer)	0–135°	95/100 5 years	E
OA 76 F	IB II (Zimmer)	Enterobacteriae, Clostridium/ ceftriaxone + teicoplanin + rifampicin	3 years	0–85°	2 surgical procedures	Arthrodesis	0°	Crutches 3 years	P
OA 75 M	Profix (S&N)	MSSA/ levofioxacin + rifampicin	7 months	0–55°	11 weeks TTO	Profix PS (S&N)	5–110°	86/75 3 years	G
OA 72 F	Génesis I (S&N)	MSSE/ ciprofioxacin + rifampicin	2 years	0–90°	8 weeks	IB-CCK (Zimmer)	0–115°	92/85 4 years	E
OA 76 F	Génesis I (S&N)	MRSA/ cotrimoxazole + rifampicin	3 years	0–80°	8 weeks Q snip	IB-CCK (Zimmer)	0–110°	95/80 3 years	G
OA 73 M	IB II (Zimmer)	MSSA/ ciprofioxacin + rifampicin	14 months	0–85°	10 weeks	IB-CCK (Zimmer)	0–110°	85/80 4 years	G
RA 70 F^f	IB II (Zimmer)	MSSE/ ciprofioxacin + rifampicin	22 months	0–90°	9 weeks	IB-CCK (Zimmer)	0–115°	90/75 5 years	G
OA 71 M	Profix (S&N)	MSSE/ levofioxacin + rifampicin	14 months	0–80°	8 weeks Q snip	Profix PS (S&N)	0–100°	85/80 2 years	G
OA 74 F	Profix (S&N)	MSSA/ ciprofioxacin + rifampicin	23 months	0–80°	10 weeks	Profix PS (S&N)	0–105°	85/70 2 years	G
RA 65 F	IB II (Zimmer)	MSSA/ ciprofioxacin + rifampicin	2 years	0–85°	11 weeks	IB-CCK (Zimmer)	0–120°	91/80 4 years	E
OA 64 F^f	Tricon-Profix revision (S&N)	Enterobacteriae/teicoplanin + rifampicin	3 months g	0–90°	9 weeks Q snip	NG LCCK (Zimmer)	0–105°	91/85 3 years	E
OA 68 F^f	Profix (S&N)	MSSA/ ciprofioxacin + rifampicin	5 weeks	0–75°	11 weeks IR	NG LCCK (Zimmer)	0–100°	90/80 3 years	G
RA 66 F^f	Miller-Galante (Zimmer)	Streptococcus + MRSA/ amoxicillinclavulanic 2 months and cotrimoxazole + rifampicin 200 days	12 years	0–85° ^h	2.5 years	0MR Hinge (Stryker)	0–100°	65/55 2 years	P
OA 73 F	Profix (S&N)	E. Coli ciprofioxacin + rifampicin	10 months	0–90°	10 weeks	NG LCCK (Zimmer)	0–120°	94/90 2 years	E
OA 69 F	Optetrak PS (ET)	MRSA/ linezolid + rifampicin	9 months	0–90°	8 weeks	Optetrak semicons. (ET)	0–95°	85/80 2.5 years	G
OA 69 F	PFC Sigma (Johnson)	Proteus mirabilis/ciprofioxacin	4 weeks	0–70°	12 weeks	Optetrak semicons. (ET)	0–95°	81/70 2 years	G
OA 67 F	Scorpio PS (Stryker)	MRSE/ cotrimoxa-zole + rifampicin	1 year	0–80°	11 weeks	Optetrak semicons. (ET)	0–105°	88/85 2 years	E
OA 68 F	Scorpio PS (Stryker)	MSSE levofioxacin + rifampicin	8 months	0–70° h	10 weeks	Optetrak revision (ET)	0–100°	82/70 2 years	G
OA 66 F	Profix (S&N)	MRSE linezolid + rifampicin	5 months	0–90°	13 weeks	NG PS (Zimmer)	0–100°	85/80 2 years	G
OA 72 M	CKS (Biomet)	MRSE cotrimoxazole + rifampicin	4 weeks	0–85°	11 weeks*	NGLCCK (Zimmer)	0–115°	90/85 4 years	E
OA 69 F	NG PS (Zimmer)	MRSE linezolid + rifampicin	10 months	0–60°	24 weeks Q-snip	NG LCCK (Zimmer)	0–100°	85/70 2 years	G
OA 70 M	NG PS (Zimmer)	MSSE/ levofioxacin + rifampicin	6 months	0–75°	10 weeks	NG LCCK (Zimmer)	0–120°	87/85 2 years	E
OA 82 F^f	NG revision PS (Zimmer)	Serratiae/ciprofioxacin	6 months	0–100°	10 weeks	MR Hinge (Stryker)	0–100°	80/55, 2 years	P
OA 68 F^f	Genesis I (S&N)	MSSA/ levofioxacin + rifampicin	4 weeks	0–90°	8 weeks	NG LCCK (Zimmer)	0–115°	93/80 2 years	G
OA 65 F	Profix (S&N)	MRSE/ cotrimoxazole + rifampicin	8 months	0–80°	8 weeks	NG PS (Zimmer)	0–100°	65/70 4 years	G
OA 77 M	NG PS (Zimmer)	MSSE + Streptococcus faecium/ rifampicin + linezolid	1.5 years	0–75°	16 weeks*	NG LCCK (Zimmer)	0–110°	95/90 2 years	E
OA 73 F^f	Genesis I (S&N)	MSSE/ ciprofioxacin + rifampicin	5 weeks	0–60°	9 weeks	IB CCK (Zimmer)	10–100°	71/55 5 years	P
OA 72 F^f	Tricon-Gen. I PS (S&N)	MSSA/ ciprofioxacin + rifampicin	4 years	0–80°	12 weeks	NG LCCK (Zimmer)	0–110°	82/80 4 years	G

^a OA: Osteoarthrosis, RA: Rheumatoid arthritis

^b TKA

 ET: Exactech

 IB: Insall-Burstein

 NG: Nex-Gen

 S&N: Smith and Nephew

^c Microorganism:

 MRSA: Methicillin resistant Staphylococcus aureus

 MSSA: Methicillin sensitive Staphylococcus aureus

 MRSE: Methicillin resistant Staphylococcus epidermidis

 MSSE: Methicillin sensitive Staphylococcus epidermidis

^d IR: Insall's realignment

 TTO: Tibial tubercle osteotomy

^g Result:

 E: Excellent

 G: Good

 F: Fair

 P: Poor

^f Multiple previous surgeries

^g from 1st revision

^h One of the components was modeled more than once. Learning curve.

 * Fresh-frozen samples +, negative cultures. Delayed reimplantation

 15 days later.

Figure 5. Subluxation of a spacer.