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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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Combined Single-Shot Infiltration Between the Popliteal Artery and Capsule of the Knee and Adductor Canal Block with Bupivacaine, Dexmedetomidine, and Dexamethasone for Total Knee Arthroplasty: A Propensity-Matched Analysis ePoster Presentation David Freccero, MD, UNITED STATES Aneesh V Samineni, BA, UNITED STATES Seroos Salavati, MD, UNITED STATES
Intraoperative Varus-Valgus Joint Laxity Pattern Was Associated With Postoperative Knee Flexion Angle and Patient-Reported Outcome Measures in Bicruciate-Stabilized Total Knee Arthroplasty. ePoster Presentation Ryota Yamagami, MD, JAPAN Kenichi Kono, MD, PhD, JAPAN Kohei Kawaguchi, MD, PhD, JAPAN Tomofumi Kage, JAPAN Ryo Murakami, MD, JAPAN Takahiro Arakawa, MD, JAPAN Hiroshi Inui, PhD, JAPAN Shuji Taketomi, MD, PhD, JAPAN Sakae Tanaka, MD, PhD, JAPAN
Intra- And Inter-Operator Reliability Assessment Of A Novel Extramedullary Accelerometer-Based Smart Cutting-Guide For Total Knee Arthroplasty: An In-Vivo Study ePoster Presentation Stefano Zaffagnini, MD, Prof., ITALY Domenico Alesi, MD, ITALY Arcangelo Russo, MD, ITALY Mirco Lo Presti, MD, ITALY Iacopo Sassoli, MD, ITALY Matteo La Verde, MD, ITALY Giulio Maria Marcheggiani Muccioli, MD, PhD, Associate Professor, ITALY
Tibia Placement Difference Between The Supine And Prone Position After Total Knee Arthroplasty: The Comparison Of The BCS and PS-TKA ePoster Presentation Takanori Iriuchishima, MD, PhD, JAPAN Keinosuke Ryu, Prof., JAPAN Eiji Cho, MD, JAPAN
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
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
Preoperative Bone Marrow Edema Negatively Impacts Intermediate to Long-Term Outcomes after Unicompartmental Knee Arthroplasty ePoster Presentation Hong Yeol Yang, MD, PhD, KOREA, REPUBLIC OF Jong-Keun Seon, MD, PhD, Prof, KOREA, REPUBLIC OF
Clinical Comparison and Survival Rate Between Unicompartmental Knee Arthroplasty and High Tibial Osteotomy With An External Fixator For Varus Knee In Patients Younger Than 60 Years at Mid-Term Follow-Up ePoster Presentation Amit Kumar Yadav, M.S (Orth),DNB(Orth),MNAMS, UNITED KINGDOM Riccardo D'Ambrosi, MD, ITALY Mangal Parihar, MS Ortho, INDIA
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
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
Diagnosis of Central Sensitization and Its Effects on Postoperative Outcomes Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis ePoster Presentation Man-Soo Kim, MD, PhD, KOREA, REPUBLIC OF Dongho Kwak, MD, KOREA, REPUBLIC OF Sungcheol Yang, MD, KOREA, REPUBLIC OF Hyukjin Jang, MD, KOREA, REPUBLIC OF Ryu Kyoung Cho, MD, KOREA, REPUBLIC OF Yong In, MD, PhD, KOREA, REPUBLIC OF
Calipered Measurements Method For Kinematically Aligned Total Knee Arthroplasty Has A Risk Of Excessive Varus Cut For The Proximal Tibia In Japanese Varus Knees ePoster Presentation Umit Kuwa, MD, PhD, JAPAN Masafumi Itoh, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN
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
Incidence and Prevention of Deep Vein Thrombosis Using Thromboprophylaxis in Total Knee Replacement: A Prospective Clinical Study ePoster Presentation Amit Lakhani, MS, DNB, MRCPS(Glassg), MNAS, INDIA
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

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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