Comparing The Efficacy Of Articulating Spacers In Two-stage Revision For Periprosthetic Joint Infection Following Total Knee Arthroplasty

Background: Periprosthetic joint infection(PJI)following total knee arthroplasty(TKA)has been one of the most serious and challenging complications.Dale et al reported that the incidence of PJI following TKA ranged from 0.5% to 2.0%.With the aging of the population,the total number of TKA is growing rapidly.As a result,the number of PJI is also increasing.At present,although there are various treatment methods for the treatment of PJI following TKA,two-stage revision is still recognized as "gold standard".The spacers used in exclusion are different,and there is no final conclusion on which spacer has more advantages in clinical application.Purpose: Few studies have compared the clinical efficacy of different articulating spacers in exclusion.This study compares the outcomes of all-cement articulating spacers and sterilized replanted metal-polyethylene articulating spacers for PJI following TKA.Methods: This retrospective observational study collected 47 cases in two-stage revision for PJI following TKA between 2006 and 2020.Patients were categorized as receiving an all-cement articulating spacer or a sterilized replanted metal-polyethylene articulating spacer in exclusion.All patients were followed up in 2021 and the follow-up time was more than 1year from two-stage revision.Data on demographics,surgical information,outcomes and imaging data were collected in 2020.Results: 47 spacers were identified: 23 all-cement spacers and 24 sterilized replanted spacers.There was no significant difference in basic information between the two groups.Patients in all –cement spacer group had shorter operation time(155.87±33.12 vs189.79±51.21 mins;P =.0102)and less blood loss(845.22±525.92 vs 1114.50±547.81 ml;P=.0427)in exclusion.Patients who received sterilized replanted spacers had superior interval ROM(61.00±31.94 vs 31.75±33.38 °;P =.0072),postoperative ROM(85.00±11.11 vs 77.37±9.18 °;P =.0329)and less use of as compared to all-cement spacers.There was basically no significant difference in blood biochemical indexes between the two groups in exclusion and revision,and there was also no significant difference in infection control rate,KSS,KSFS,and imaging data analysis between the two groups.Conclusion: The two types of spacers had no difference in reinfection rates,indicating that both articulating spacer types may be safe and effective options for two-stage revision.Considering ROM of knee joint,bone loss and cost,sterilized replanted Metal-Polyethylene spacers are worthy of spread in the treatment of PJI.