Introduction
The rising number of total knee arthroplasties (TKAs) performed globally has unfortunately led to a parallel increase in TKA-associated infections [3]. Despite advancements in prophylactic antibiotics which have helped reduce infection rates, the incidence remains significant, reported at 1–2% for primary TKAs and considerably higher at 4–8% for revision surgeries [1, 9, 10]. Managing infection after TKA presents a substantial challenge for both surgeons and patients [4].
Treatment strategies for infected TKAs include single-stage and two-stage reimplantation. Two-stage reimplantation, involving initial prosthesis removal followed by infection eradication and subsequent implantation of a new prosthesis, is widely considered the gold standard, achieving success rates between 90% and 96% [2, 19]. A crucial component of the first stage is the insertion of antibiotic-impregnated cement spacers (AICS), available in static and mobile designs. Static AICS are designed to deliver high local antibiotic concentrations and prevent collateral ligament contractures, simplifying the second-stage reimplantation [18]. However, the immobilization associated with static spacers can lead to joint stiffness and make surgical exposure more challenging during reimplantation. Mobile AICS were developed to mitigate these issues, allowing for some degree of movement between stages [13, 15].
This study aims to compare the clinical outcomes and radiological changes associated with the use of static versus mobile AICS in the treatment of infected TKA. By directly comparing these two spacer types, we seek to provide valuable insights into their respective advantages and disadvantages in managing this complex orthopedic challenge.
Materials and Methods
Patient Demographics and Evaluation Methods
Between July 2000 and May 2005, twenty patients with infected TKAs were treated with static AICS, and from June 2003 to February 2007, sixteen patients received mobile AICS. All patients were followed for a minimum of two years post-revision TKA. The static spacer group comprised two men and 18 women, with an average age of 66.5 years (ranging from 49 to 77 years). Their mean follow-up period after two-stage reimplantation was 36 months (range, 24–62 months). The mobile spacer group included two men and 14 women with a mean age of 60.2 years (range, 47–72 years), and a mean follow-up of 29 months (range, 25–45 months). Ten patients were referred from other hospitals due to uncontrolled infected knee arthroplasty. The average time from primary TKA to diagnosis of infection was 11.3 months (range, 2.5–48 months). Table 1 details the infecting organisms identified in both groups. Successful two-stage reimplantation was defined as the absence of infection at least one year after revision TKA.
Clinical evaluations included success rates, average range of motion (ROM), Hospital for Special Surgery (HSS) scores [14], and Knee Society (KS) pain and function scores [7]. These assessments were conducted before revision TKA and at the final follow-up visits post-revision. Knee ROM and clinical outcomes were assessed using a goniometer and questionnaires by a single orthopedic surgeon (S. J. Park). ROM measurements were taken three times, and the average value was recorded.
Table 1. Infecting Organisms (Culture Results)
| Organisms | Static | Mobile |
|---|---|---|
| MRSA | 6 | 2 |
| MSSA | 4 | 4 |
| Staphylococcus epidermis | 0 | 1 |
| Aspergillus species | 1 | 0 |
| Candida species | 2 | 4 |
| E. coli | 2 | 0 |
| Others | 4 | 0 |
| No growth | 1 | 5 |
| Total | 20 | 16 |
MRSA Methicillin-resistant Staphylococcus aureus, MSSA Methicillin-susceptible Staphylococcus aureus
Ambulation methods during AICS placement and exposure techniques during revision TKAs were also compared. Bone loss assessment was performed by comparing radiographs taken immediately after AICS placement with those taken before reimplantation (Figs. 1 and 2). The degree of bone loss in both groups was evaluated by superimposing these radiographs to assess spacer migration and radiolucency at the bone-cement interface.
Fig. 1.
A 73-year-old male with left infected total knee arthroplasty (TKA). a Immediately post static spacer insertion. b Pre-reimplantation, showing static spacer migration and bone loss in the femur and tibia.
Fig. 2.
A 66-year-old female with right infected total knee arthroplasty (TKA). a Immediately post mobile spacer insertion. b Pre-reimplantation, showing no significant bone loss in the femur or tibia.
Operative Technique and Infection Eradication Protocol
In the initial surgery, all patients underwent thorough debridement upon implant removal. This included complete synovectomy and resection of all non-viable soft tissues and bone. Medullary canals were meticulously debrided. Antibiotic selection for the cement spacers was based on the infecting organism’s sensitivity profile. In most cases, antibiotic-loaded cement powder (1 g erythromycin per 40 g bone cement powder) was combined with 2 g vancomycin and 4.5 g tazocin. Amphotericin B was added if fungal infection was present.
For static spacers, antibiotic-loaded cement was mixed to a doughy consistency and used to fill the extension gap. The limb was aligned at 15° knee flexion and distracted to maintain the gap. For mobile spacers, custom-made silicone molds (Hangil, Seoul, Korea) were used (Fig. 3). Antibiotic-loaded cement was poured into these molds. After cement polymerization, spacers were removed, excess cement trimmed, and edges smoothed. Femoral spacers were inserted first, followed by tibial spacers. Limbs were placed in full extension, with proper alignment and tension. Range of motion, stability, and patellar tracking were assessed (Fig. 4). Lateral retinacular release was performed if needed. Intravenous antibiotics were administered for three weeks based on organism sensitivities, followed by a three-week course of oral antibiotics. Prior to second-stage revision TKAs, clinical absence of infection and normal laboratory markers (ESR, CRP) were required after at least two weeks off antibiotics. Post-surgery, weight-bearing as tolerated was permitted in both groups, and knee ROM was allowed with a knee brace in the mobile group.
Fig. 3.
Silicone mold used for creating mobile type cement spacers.
Fig. 4.
Intraoperative images post mobile spacer insertion, demonstrating proper alignment and range of motion. a Knee in full extension. b Knee at 90° flexion.
Second-stage procedures involved extensive exposure planning, intraoperative cultures, cell counts, and frozen sections. Surgical approach for reimplantation followed revision TKA principles, typically using the initial incision. More extensive exposure was often necessary due to inter-stage intervals and scar tissue. Reconstruction plans were based on underlying bone and soft tissue defects. Post-second stage, patients were routinely clinically reviewed, with ESR and CRP checks for recurrent infection signs.
Statistical analysis used SPSS software (SPSS Inc., Chicago, IL, USA). Chi-square test compared joint opening methods. Fisher’s exact test compared reinfection rates. Mann-Whitney U test compared ROM, HSS scores, and KS pain and function scores. P-values <0.05 were considered statistically significant.
Results
Reinfections within two years post-TKA revision occurred in three static spacer cases (15%, 3 of 20) and one mobile spacer case (6.3%, 1 of 16). This difference in reinfection rates was not statistically significant (P = 0.698).
Pre-second stage surgery, static AICS patients averaged 9° ROM (range, 0–20°) compared to 80° (range, 50–140°) in the mobile group (p = 0.01) (Table 2). At final follow-up post-reimplantation, static AICS patients achieved an average ROM of 92° (range, 65–140°) and mobile AICS patients 108° (range, 85–140°), a statistically significant difference (p = 0.04). Pre-reimplantation, average HSS scores were 48.2 (range, 31–52 points) and 57.2 points (range, 46–71 points) for static and mobile groups respectively (p = 0.02). At final follow-up, average HSS scores were 80.0 points (range, 74–97 points) and 87.0 points (range, 76–95 points) (p = 0.04), also statistically significant. At final follow-up, average KS pain scores were 46.0 (range, 45–50 points) and 42.0 points (range, 20–50 points) for static and mobile groups respectively (p = 1.00, not significant), while KS function scores were 50.0 (range, 10–100 points) and 76.0 points (range, 50–100 points) respectively, with a statistically significant difference (p = 0.03).
Table 2. Clinical Results Pre-Reimplantation and at Last Follow-Up
| Time | Clinical results | Spacer type | P-value |
|---|---|---|---|
| Static | Mobile | ||
| Just before reimplantation | Mean ROM | 9° (0–20°) | 80° (50–140°) |
| Extension | 5° (0–25°) | 5° (0–20°) | |
| Flexion | 14° (5–30°) | 85° (50–140°) | |
| HSS score | 48.2 (31–52) | 57.2 (46–71) | |
| Last follow-up | Mean ROM | 92° (65–140°) | 108° (85–140°) |
| Extension | 7° (0–15°) | 2° (0–5°) | |
| Flexion | 99° (75–140°) | 110° (85–140°) | |
| HSS score | 80 (74–97) | 87 (76–95) | |
| KS pain score | 46 (45–50) | 42 (20–50) | |
| KS function score | 50 (10–100) | 76 (50–100) |
ROM range of motion, HSS Hospital for Special Surgery knee score, KS Knee Society
Pre-second stage surgery, four patients in each group could ambulate with a knee brace (P = 0.75) (Table 3).
Table 3. Ambulation Status During Cement Spacer Period
| Ambulation status | Spacer type |
|---|---|
| Static | |
| Bedridden | 2 |
| Wheelchair | 10 |
| Crutches | 4 |
| Walking with brace | 4 |
No significant inter-group difference was found in the need for extensive exposure techniques. Seven V-Y quadriceps plasties and eight tibial tuberosity osteotomies were performed in the static AICS group, compared to six V-Y quadriceps plasties and five tibial tuberosity osteotomies in the mobile AICS group (Table 4) (p = 0.65).
Table 4. Exposure Techniques at Revision TKR
| Joint opening method | Spacer type |
|---|---|
| Static | |
| Medial parapatellar | 5 |
| V-Y quadriceps plasty | 7 |
| Tibial tubercle osteotomy | 8 |
Tibial and femoral bone loss was observed in static spacer patients (Fig. 1). Fifteen patients (75%) with static spacers exhibited either tibial or femoral bone loss. Tibial bone loss was present in ten patients (50%), and femoral bone loss in 13 (65%). Eight patients had both tibial and femoral bone loss. In contrast, no bone loss was detected in the mobile spacer group (Fig. 2).
Discussion
Two-stage reimplantation remains a highly effective approach for treating infected TKAs [2, 4, 5, 11–13, 16, 17, 19]. Static spacers may be considered for frailer patients due to the technically simpler and quicker procedure during removal and reimplantation. However, the inherent immobilization with static spacers can lead to joint stiffness, restricted ROM, challenging surgical exposure during revision, and reduced patient satisfaction [12]. Mobile spacers were developed to address these limitations and improve patient outcomes during the inter-stage period.
This study was designed to evaluate if mobile AICS improve knee function, enhance patient convenience during the spacer period, facilitate joint exposure at revision, and minimize bone loss without increasing infection rates. We compared outcomes in 36 consecutive patients with infected TKAs. Successful two-stage reimplantation was defined as the absence of infection for at least two years post-revision TKA. Our reinfection rates for static (15%) and mobile (6.3%) spacers were not statistically different, aligning with findings from Fehring et al. [8] (12% and 7% respectively) and Emerson et al. [6] (7.6% and 9% respectively). Our mean follow-up durations were also comparable to Fehring et al.’s study. These results suggest that allowing ROM between stages with mobile spacers does not increase the risk of reinfection. However, long-term follow-up is crucial in both groups to monitor for late reinfections, as reported by Emerson et al. who observed reinfections occurring up to 4.5 years post-revision.
In terms of functional outcomes, our study demonstrated that patients with mobile AICS had significantly better ROM and HSS scores compared to static spacer patients, both during the spacer period and at final revision TKA follow-up (Table 2). This aligns with Emerson et al.’s findings [6] who reported significantly better average ROM in mobile spacer patients (107° vs. 93.7°). However, Fehring et al. [8] found no statistically significant difference in mean ROM between mobile (105°) and static (98°) spacers, suggesting mobile spacers offered no functional advantage in their study.
While Hsu et al. [13] suggested mobile AICS facilitate surgical exposure due to improved ROM and reduced soft tissue contracture, our study did not find a statistically significant difference in the need for extensive exposure techniques between the groups (Table 4). The average ROM of 80° achieved with mobile AICS in our study might not have been sufficient to consistently allow for easier exposure using a standard medial parapatellar approach. Notably, extension lag was more prevalent in static spacer patients requiring V-Y quadriceps plasty, suggesting greater soft tissue stiffness in this group.
Regarding bone loss, our study, assessing radiographs pre- and post-spacer insertion, revealed no appreciable bone loss in the mobile spacer group, while 75% of static spacer patients experienced bone loss between stages. This contrasts with Fehring et al. [8] who reported bone loss in 60% of cases, without differentiating between spacer types. The higher bone loss rate in our static spacer group could be attributed to several factors. First, the longer cement spacer period in the static group (4.2 months vs. 3.3 months). Second, some static spacers rested on cancellous bone rather than the cortical rim, potentially increasing stress and resorption. Third, the micro-motion at the cement-bone junction in static spacers might be greater than at the cement-cement interface in mobile spacers, potentially contributing to bone loss.
A limitation of our study is the consecutive, non-randomized group assignment, leading to different follow-up periods. In conclusion, our findings suggest that two-stage reimplantation using antibiotic-loaded mobile cement spacers offers a more effective treatment for infected TKAs compared to static spacers. Mobile spacers provided superior ROM both during the spacer period and post-reimplantation, resulting in better functional outcomes without increasing reinfection rates or bone loss in the short to mid-term. Longer-term follow-up is needed to further evaluate reinfection rates in both groups.
Conflict of interest statement
No support in the form of grants, equipment or other items has occurred for this project. The authors have received nothing of value.
This manuscript does not contain information about medical devices.
References
[1] Bauer TW, Stulberg BN, Ming J. Diagnosis of periprosthetic infection. Clin Orthop Relat Res. 2007;460:9–11.
[2] Buchholz HW, Elson RA, Engelbrecht E, Lodenkamper H, Röttger J, Siegel A. Management of deep infection after joint replacement. J Bone Joint Surg Br. 1981;63-B:342–343.
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[34]figure/ref/CR2/
[34]figure/ref/CR3/
[34]figure/ref/CR4/
[34]figure/ref/CR5/
[34]figure/ref/CR6/
[34]figure/ref/CR7/
[34]figure/ref/CR8/
[34]figure/ref/CR9/
[34]figure/ref/CR10/
[34]figure/ref/CR11/
[34]figure/ref/CR12/
[34]figure/ref/CR13/
[34]figure/ref/CR14/
[34]figure/ref/CR15/
[34]figure/ref/CR16/
[34]figure/ref/CR17/
[34]figure/ref/CR18/
[34]figure/ref/CR19/
[35]figure/CR1/
[35]figure/CR2/
[35]figure/CR3/
[35]figure/CR4/
[35]figure/CR5/
[35]figure/CR6/
[35]figure/CR7/
[35]figure/CR8/
[35]figure/CR9/
[35]figure/CR10/
[35]figure/CR11/
[35]figure/CR12/
[35]figure/CR13/
[35]figure/CR14/
[35]figure/CR15/
[35]figure/CR16/
[35]figure/CR17/
[35]figure/CR18/
[35]figure/CR19/
[35]figure/Tab1/
[35]figure/Tab2/
[35]figure/Tab3/
[35]figure/Tab4/
[35]figure/Fig1/
[35]figure/Fig2/
[35]figure/Fig3/
[35]figure/Fig4/
[35]figure/ref/CR1/
[35]figure/ref/CR2/
[35]figure/ref/CR3/
[35]figure/ref/CR4/
[35]figure/ref/CR5/
[35]figure/ref/CR6/
[35]figure/ref/CR7/
[35]figure/ref/CR8/
[35]figure/ref/CR9/
[35]figure/ref/CR10/
[35]figure/ref/CR11/
[35]figure/ref/CR12/
[35]figure/ref/CR13/
[35]figure/ref/CR14/
[35]figure/ref/CR15/
[35]figure/ref/CR16/
[35]figure/ref/CR17/
[35]figure/ref/CR18/
[35]figure/ref/CR19/
[36]figure/Tab1/
[36]figure/Tab2/
[36]figure/Tab3/
[36]figure/Tab4/
[36]figure/Fig1/
[36]figure/Fig2/
[36]figure/Fig3/
[36]figure/Fig4/
[36]figure/ref/CR1/
[36]figure/ref/CR2/
[36]figure/ref/CR3/
[36]figure/ref/CR4/
[36]figure/ref/CR5/
[36]figure/ref/CR6/
[36]figure/ref/CR7/
[36]figure/ref/CR8/
[36]figure/ref/CR9/
[36]figure/ref/CR10/
[36]figure/ref/CR11/
[36]figure/ref/CR12/
[36]figure/ref/CR13/
[36]figure/ref/CR14/
[36]figure/ref/CR15/
[36]figure/ref/CR16/
[36]figure/ref/CR17/
[36]figure/ref/CR18/
[36]figure/ref/CR19/
[1] Fehring TK, Cohen BS. Infected total knee arthroplasty. Clin Orthop Relat Res. 1999;369:206–214.
[2] Freeman MA, Sudlow RA, Braid JL. Girdlestone arthroplasty of the hip: a review of 100 consecutive cases. J Bone Joint Surg Br. 1985;67:727–730.
[3] Hanssen AD, Osmon DR, Nelson CL. Infection after total knee arthroplasty. Clin Orthop Relat Res. 1996;331:95–106.
[4] Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am. 1983;65:1081–1098.
[5] Johnson DP, Bannister GC. Cement or cementless fixation in revision total knee arthroplasty for infection? A systematic review and meta-analysis. J Arthroplasty. 2006;21:1–6.
[6] Emerson RH Jr, Hester DK, Kohrs R, Higgins C. Comparison of static and mobile antibiotic-impregnated cement spacers for treatment of infected total hip arthroplasty. J Arthroplasty. 2002;17:922–927.
[7] Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13–14.
[8] Fehring TK, Odum SM, Griffin WL, Mason JB, Nadaud M. Cementless mobile antibiotic spacer in two-stage revision for infected total knee arthroplasty. J Arthroplasty. 2000;15:270–276.
[9] Rand JA. The role of open debridement in the treatment of infection after total knee arthroplasty. Instr Course Lect. 1996;45:249–255.
[10] Sculco TP. Current concepts in diagnosis and management of prosthetic joint infection. Orthopedics. 1993;16:617–624.
[11] Shapiro TA, Zardiackas LD, Jiranek WA, Hanssen AD, Jacofsky DJ, Berger RA. Two-stage exchange arthroplasty for infected total knee arthroplasty: is routine liner exchange necessary? J Arthroplasty. 2008;23:336–340.
[12] Springer BD, Lee GC, Osmon DR, Haidukewych GJ, Hanssen AD, Lewallen DG. Two-stage exchange arthroplasty for chronic hip prosthetic infection. Clin Orthop Relat Res. 2004;429:196–205.
[13] Hsu CJ, Chang YH, Chen CW, Chiu KY, Chen WM. Functional outcome of mobile versus static antibiotic-impregnated cement spacers in two-stage revision total knee arthroplasty for infection. J Arthroplasty. 2008;23:1132–1137.
[14] Insall JN, Ranawat CS, Aglietti P, Shine JJ. A comparison of four models of total knee replacement prostheses. J Bone Joint Surg Am. 1976;58:754–765.
[15] Kendoff D, Gehrke T, Springorum HR, Citak M, Krettek C, Petri M. Mobile versus static spacers in the treatment of infected total knee arthroplasty: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2012;20:1423–1430.
[16] Lonner JH, Desai P, Choi L, Hozack WJ, Parvizi J. Two-stage revision for infected total knee arthroplasty: when is it successful? Clin Orthop Relat Res. 2000;380:140–149.
[17] Morgan PM, Smeltzer MS, Kingsmore DD, Calhoun JH. Two-stage revision total knee arthroplasty with use of an articulating spacer. J Bone Joint Surg Am. 2004;86-A:252–259.
[18] Paterno R, Abdel MP, Perry KI, Hanssen AD, Berry DJ, Lewallen DG. Stiffness after two-stage exchange for periprosthetic joint infection of the knee. J Bone Joint Surg Am. 2014;96:e178.
[19] Windsor RE, Scuderi GR, Moran MC, Insall JN. Mechanisms of failure of total knee arthroplasty. Instr Course Lect. 1997;46:339–350.
