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Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

Gloria Shoshana Coden, MD
UNITED STATES

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Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

Gloria Shoshana Coden, MD, UNITED STATES Suzanne Kent, MD, UNITED STATES Ruijia Niu, MPH, UNITED STATES Ayesha Abdeen, MD, UNITED STATES Eric L. Smith, MD, UNITED STATES

New England Baptist Hospital, Boston, MA, UNITED STATES

2023 Congress ePoster Presentation 2023 Congress Not yet rated

Anatomic Location

Knee

Treatment / Technique

Failed Arthroplasty Total Joint Replacement

Diagnosis / Condition

Infection

Summary: Ultrastatic spacer is a two nail construct that provides stable fixation during treatment of periprosthetic infections after total knee arthroplasty.

Introduction

Prosthetic joint infection (PJI) is a rare but devastating complication after total knee arthroplasty (TKA). While guidelines clearly recommend treatment to include removal of the infected hardware and placement of an antibiotic impregnated spacer to maintain the patient’s leg length, the most stable construct for knee arthrodesis has not been established. Therefore, we sought to describe our technique evaluate the outcomes when using an ultrastatic spacer to treat PJI after TKA.

Methods

We retrospectively reviewed 11 patients who underwent placement of an ultrastatic spacer between 10/29/2020 and 3/23/2022. All patients were indicated for placement of the ultrastatic spacer for periprosthetic infection after TKA. Medical records were reviewed for demographics, infectious organism, antibiotic therapy, complications, outcomes, and if patient underwent additional revision surgeries.
The ultrastatic spacer was constructed using a retrograde femoral and antegrade tibial nail that overlap to span the knee joint. The nails were tied together using 16-guage wire. Antibiotic cement impregnated with three grams of tobramycin and five grams of vancomycin were then hand impacted into the bone defects and to span the knee joint.

Results

Mean age at time of implantation was 62.6 years and 81.8 percent (%) of patients were male. 90.9% of patients required placement of a right ultrastatic spacer. Infectious etiologies were identified in eight patients: three patients with staphylococcus epidermidis, one with methicillin-sensitive staphylococcus aureus (MSSA), one with methicillin-resistant staphylococcus aureus, one with Enterobacter cloacae, one with a combination of MSSA, cutibacterium acnes, and mold, and one with a combination of staphylococcus epidermidis, Enterobacter cloacae, and pseudomonas stutzeri. Three patients’ cultures did not grow any organisms, but intraoperative findings were consistent with periprosthetic infection. Postoperatively, all patients received an antibiotic regimen based on microbiology sensitivity testing.
Four patients cleared their PJI and underwent revision TKA or distal femoral replacement. Three of those patients continue to have no evidence of their periprosthetic infection and remain on chronic antibiotic suppressive therapy, while one patient had recurrence of MSSA in the setting of a quadriceps rupture. One additional patient also cleared the PJI and underwent permanent fixation with a modular knee arthrodesis due to loss of his extensor mechanism not amenable to repair. Four patients underwent revision of the ultrastatic spacer due to persistent PJI. Two of these patients were revised to another ultrastatic spacer and two patients underwent implantation of an antibiotic cement spacer with single nail construction. Two patients still have their ultrastatic spacer implanted at most recent follow-up. Average time that the ultrastatic spacer was implanted in each patient was 182.36 days.

Discussion

The ultrastatic spacer provides stable fixation for patients with a PJI after TKA with a mean time to revision of 182.36 days. In combination with systemic antibiotic therapy, the ultrastatic spacer successful at resolving 45.45% of PJI. Surgeons should be aware that the ultrastatic spacer is a viable option for treatment of PJI and the technique for implantation.

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The Functional Outcome of Zimmer Biomet’s Nexgen Total Knee Arthroplasty as Compared with Healthy Older Adults ePoster Presentation Gwenllian F. Tawy, PhD, MRes, BSc(Hons), UNITED KINGDOM Michael J. McNicholas, BSc, MD, FRCS Tr & Orth, UNITED KINGDOM Leela C. Biant, MS, MFSTEd, FRCSEd(Tr&Orth), UNITED KINGDOM
Accuracy of Advanced Active Robotic Technology for Total Knee Arthroplasty: A Cadaveric Study ePoster Presentation Yong-Beom Park, MD, PhD, KOREA, REPUBLIC OF Seong-Hwan Kim, MD,Ph.D, MStat, KOREA, REPUBLIC OF Young-Bong Ko, MD, KOREA, REPUBLIC OF
Use of Tibial Stem for Patients with Morbid Obesity in Total Knee Arthroplasty ePoster Presentation José Eduardo Flores Naranjo, MD, MEXICO Adrian Aziz Cortes De La Fuente, MD, MEXICO Octavio Martinez Montiel, MD, MEXICO Fernando Martinez Zuñiga, MD, MEXICO
Participation of Physical Activity Following Knee Arthroplasty: A Meta-Analysis ePoster Presentation Ahmed A Magan, BM BSc (Hons) MRCS (Eng) FRCS (Eng) Trauma & Orth, UNITED KINGDOM Babar Kayani, BSc (HONS), MBBS, MRCS (Eng), UNITED KINGDOM Warran Wignadasan, MBBS, BSc (Hons), MRCS, UNITED KINGDOM Dia Eldean Giebaly, MBChB, MSc, FRCS, EMBA, UNITED KINGDOM Flaminia Ronca, PHD, UNITED KINGDOM Fares S. Haddad, MCh(Orth), BSc, FRCS(Orth), UNITED KINGDOM
Effect of Altered Knee Joint Loading Pattern in Gait Biomechanics of Total Knee Arthroplasty Patient ePoster Presentation Sang Jin Lee, MD, PhD, KOREA, REPUBLIC OF
No Difference In Sports Participation And Patient-Reported Functional Outcomes Between Total Knee Arthroplasty And Unicompartmental Knee Arthroplasty At Minimum 2-Year Follow-Up In A Matched Control Study ePoster Presentation Amit Meena, MBBS, MS, DNB, INDIA Elisabeth Abermann, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Luca Farinelli, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Akshya Raj, MBBS,MS, INDIA Mohit Kumar Patralekh, MBBS, MS(Orthopaedics), DNB(Orthopaedics), MNAMS, INDIA Christian Fink, MD, Prof., AUSTRIA
Patellar Medial-lateral Position can be Used to Correct the Effect of Leg Rotation on Preoperative Planning in Total Knee Arthroplasty for Varus Knees ePoster Presentation Shinichiro Nakamura, MD, PhD, JAPAN Shota Takemoto, MD, JAPAN Shinichi Kuriyama, MD, PhD, JAPAN Kohei Nishitani, MD, PhD, JAPAN Hiromu Ito, MD, PhD, JAPAN Mutsumi Watanabe, MD, PhD, JAPAN Young Dong Song, MD, PhD, UNITED STATES Shuichi Matsuda, MD, PhD, JAPAN
Effect of Restricted Kinematic Alignment Total Knee Arthroplasty on Coronal Plane Alignment Of The Ankle Joint ePoster Presentation Bartosz Michał Maciąg, MD, POLAND Marcin Łapiński, MD, POLAND Tomasz Mrozek, MD, POLAND Adrian Góralczyk, MD, POLAND Maciej Swiercz, MD, POLAND Grzegorz Maciąg, POLAND Krystian Żarnovsky, POLAND Olga Adamska, POLAND Artur Stolarczyk, MD, PhD, POLAND
Total Knee Arthroplasty Without Patellar Component Replacement. Does it Increase the Risk of Revision? Local Experience Analysis ePoster Presentation Zoy Anastasiadis, MD, CHILE Diego Edwards, MD, CHILE Sergio Arellano, MD, CHILE Andrés Schmidt-Hebbel, MD, CHILE Eduardo Gardella, MD, CHILE Nicolás González-Kusjanovic, MD, CHILE Alex Vaisman, MD, Prof., CHILE
Comparative Analysis Of Time Taken In Conventional vs. Robotic Assisted Total Knee Arthroplast ePoster Presentation Sanjay B. Londhe, MS, FRCS, FRCSI, MCh, INDIA Santosh Chandrashekar Shetty, MS, INDIA Ashit Hasmukhbhai Shah, FRCS Orth, M ChOrth, M S Orth, D N B Orth, INDIA Niraj Vora, MS,MRCS, INDIA Vijay Shetty, MD, MSc, FRCSC, INDIA Rakesh Nair, MS, INDIA Clevio Joao Baptista Desouza, MS , INDIA Farheen Khan, B.Tech, INDIA
Factors Associated With Failure and Survivorship Following Unicompartmental Knee Arthroplasty: A Single-Center Experience ePoster Presentation Anirudh K Gowd, MD, UNITED STATES Johannes F. Plate, MD, PhD, UNITED STATES Asher Lichtig, MD, UNITED STATES Orhan Yanmis, MD, UNITED STATES Gary G. Poehling, MD, UNITED STATES

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Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

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Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

Treatment of Periprosthetic Infection after Total Knee Arthroplasty using an Ultrastatic Spacer

Introduction

Methods

Results

Discussion

More 2023 ISAKOS Congress Content