| Background:Infection in total knee arthroplasty(TKA)is a devastating complication for patients and surgeons alike.Antibiotic-loaded articulating spacers play an important role in increasing infection control rates or decreasing postoperative reinfection rates.Based on the materials of the surfaces of femoral components and tibial components,articulating spacers can be divided into two categories.One is the all-cement articulating spacers,the other one is the articulating spacers containing bio-inert materials(metal or plastic).However,the bio-inert material may provide a suitable surface for bacteria to attach and form the biofilm.There are multiple concerns regarding the possibility of microorganisms adhering to either a metallic or plastic prosthesis,which may lead to a lower infection control rate and higher reinfection rate after revision.A limited number of studies have concentrated on the clinical results of the infection control rate and the reinfection rate between prosthetic spacers and all-cement spacers.Purposes:To review the history and development of spacers applied in two-stage revision after infected TKA.Besides,we compared articulating spacers containing bio-inert materials(metal or plastic)with all-cement articulating spacers with respect to the infection control rates at stage I and the postoperative reinfection rates after revision.The aim of this review was to analyse to what extent the infection eradication rates differ between the two types of articulating spacers,and to provide valuable information for surgeons to choose an optimal spacer.Methods:We comprehensively searched PubMed,Embase,and the Cochrane Library databases with the key words "total knee arthroplasty","TKA","total knee replacement”,"TKR","periprosthetic infection","PJ" and "spacers",and performed a systematic review and meta-analysis of retrospective comparative studies assessing two types of articulating spacers.A quality assessment of the included studies was performed following the STROBE statement.Gender,mean ages and bacterial strains of the two groups were compared using a Chi-square test performed by SPSS.The pooled infection control rates as well as the postoperative reinfection rates between two articulating spacer groups were analysed using R software.SPSS was also used for the subgroup analyses,including the weight of antibiotics in cement,the type of antibiotics in cement,the mean period of spacers in situ,the length of postoperative antibiotic treatment and the approach of postoperative antibiotic treatment.Normality was assessed by Shapiro's test.Statistical heterogeneity between studies was assessed using the Q statistic(Chi-square test)and I2 statistic.Result:Thirty retrospective studies,including a total of 821 knees,were identified.The pooled infection control rates in stage I were as follows:0.98(95%confidence interval[CI],0.97 to 1.00)and 0.98(95%CI,0.96 to 0.99)for the prosthetic articulating spacer group and all-cement articulating spacer group,respectively.The pooled postoperative reinfection rate was 0.05(95%CI,0.03 to 0.08)for the prosthetic spacer group and 0.03(95%CI,0.01 to 0.06)for the all-cement spacer group.Results of the subgroup analyses showed that the weight of the antibiotic cement,antibiotic type,mean period of spacers in situ,postoperative antibiotic treatment period,and postoperative antibiotic treatment approach had no effect on the reinfection rates(p<0.05).Conclusion:Compared to all-cement articulating spacers,articulating spacers containing bio-inert materials have a similar infection control rate but a higher postoperative reinfection rate.Although the 95%CIs of reinfection rates in the two groups overlapped,our results indicate that articulating spacers containing bio-inert materials may be associated with higher reinfection rates and poorer clinical outcomes than all-cement articulating spacers. |
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