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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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Comparison of Outcomes between Fungal and Non-fungal Periprosthetic Joint Infections in Total Knee Arthroplasty: A Propensity Score-Matched Analysis ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Anatomical distribution of radiological OA Influences the Outcome of TKA ePoster Presentation Johanna Elliott, MB, BS, B.Med Sci, Master Science, GERMANY
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
Golfers Have Greater Preoperative and Equal Postoperative Function When Undergoing Total Knee Arthroplasty Compared to Non-Golfers ePoster Presentation Patrick G Robinson, MBChB, MRCS, MS, MBA, UNITED KINGDOM Robert Kay, MBChB, UNITED KINGDOM Deborah Macdonald, BA(Hons), UNITED KINGDOM Andrew Murray, MBChB, FFSEM, UNITED KINGDOM Nick David Clement, MBBS, MD, PhD, FRCS(Orth), UNITED KINGDOM
Patella in Total Knee Replacement: Patellar Resurfacing has Better Outcomes than Lateral Facetectomy at One Year Follow-Up ePoster Presentation Tomas Alfredo Esteves, MD, ARGENTINA Matias Novillo, MD, ARGENTINA Tomas Nicolino, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Lisandro Carbó, MD, ARGENTINA Julian Costantini, MD, ARGENTINA
Success of Debridement, Antibiotics, and Implant Retention vs Revision In Early And Late Prosthetic Joint Infections Following Primary TKA: A Prospective, Multicenter Study of 251 Cases ePoster Presentation Mark Zhu, MBChB, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Laurens Manning, MBChB, AUSTRALIA Sarah Metcalf, MBChB, NEW ZEALAND Simon W. Young, MD, FRACS, NEW ZEALAND
Short Term Outcome of Tibial Defect Reconstruction In Primary Total Knee Arthroplasty: A Retrospective Study ePoster Presentation Sanjib Kumar Behera, MS (Orth), DNB (Rehab), DPMR, INDIA Madhumita Pradhan, BDS, MPH, MHA , INDIA Vikram Choudhary, MD, UNITED STATES
Large Reduction In Postoperative Posterior Tibial Slope Risks Anterior Collapse Of The Tibial Component In Fixed-Bearing Unicompartmental Knee Arthroplasty ePoster Presentation Kazuhisa Hatayama, MD, PhD, JAPAN Masanori Terauchi, MD, JAPAN Shingo Kurihara, MD, JAPAN Satoshi Nonaka, MD, JAPAN Hibiki Kakiage, MD, JAPAN
Subtalar Joint Compensation using Full-length Standing Lower Extremity Anteroposterior Radiograph after Total Knee Arthroplasty for Varus Osteoarthritis in Nara Medical University Hospital with 2-year Follow-up ePoster Presentation Jerre Co De Guzman, MD, PHILIPPINES Munehiro Ogawa, MD, PhD, JAPAN Yusuke Ozaki, MD, JAPAN Yasuhito Tanaka, Prof., JAPAN Yuki Nishimura, MD, JAPAN Maria Elizabeth Mercado, MD, MAS, PHILIPPINES
The Effect of Minor Adjustments to Tibial and Femoral Component Position on Soft Tissue Balance in Robotic Total Knee Arthroplasty ePoster Presentation Simon W. Young, MD, FRACS, NEW ZEALAND Matthew Carter, NEW ZEALAND Gavin William Clark, MBBS, FRACS, AUSTRALIA Christina Esposito, PhD, AUSTRALIA Matthew Walker, MBChB, FRACS, NEW ZEALAND
Short-Term Clinical Outcome Of Functionally Aligned Robotic-Assisted BCS TKA is Better Than That Of Mechanically Aligned Navigation-Assisted BCS TKA ePoster Presentation Daisuke Hamada, MD, PhD, JAPAN Keizo Wada, MD, JAPAN Yasuaki Tamaki, MD, JAPAN Yasuyuki Omichi, MD, JAPAN Tomohiro Goto, MD, PhD, JAPAN Koichi Sairyo, MD, PhD, JAPAN
Total Knee Arthroplasty Outcomes Following Anterior Cruciate Ligament Reconstruction ePoster Presentation Brian Rao, BS, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Eric Milliron, BS, UNITED STATES Parker Cavendish, BS, UNITED STATES James C. Kirven, BS, UNITED STATES Spencer E. Talentino, MD, UNITED STATES Charles Qin, MD, UNITED STATES Ryan H. Barnes, MD, UNITED STATES Robert A. Duerr, MD, UNITED STATES Christopher C. Kaeding, MD, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES David C. Flanigan, 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

Introduction

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Discussion

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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