Recovery of knee mobility after a static or mobile spacer in total knee infection.

The purpose of the study was to compare the recovery of knee mobility after two-stage revision of an infected total knee arthroplasty using a static or mobile spacer. At 12 months follow-up, none of the patients had a recurrent infection of their new prosthesis. Knee flexion was lower in the static spacer group at 3, 6 and 12 months postoperatively. Patients that received a mobile spacer had a better and faster recovery of their knee function. The operation time of re-implantation was shorter in the mobile spacer group than in the static spacer group. Our results suggest that patients treated with a mobile spacer have a faster recovery of the knee range of motion and a shorter operation time, including for the subsequent re-implantation of a prosthesis. Our results support the use of the mobile spacer in patients with an infected TKA that are treated with a two-stage revision of the prosthesis.

Resection arthroplasty combined with a muscle graft to treat refractory post-total knee arthroplasty infections.

For refractory post-total knee arthroplasty infections, resection arthroplasty combined with muscle grafting has been conducted to control the infection while preserving the infected limb. Resection arthroplasty was conducted on 9 patients (10 knees) with post-total knee arthroplasty refractory infection. All infections were brought under control. Seven patients were pain free, and mild pain persisted in 2 after walking and during locomotion. The average range of knee motion was 67 degrees. The mean discrepancy in leg length was 5.2 cm. There was no recurrence of infection in any patient. The function of each knee was accepted. Resection arthroplasty combined with muscle transfer is an effective method if the individuals desire to preserve the affected limbs for religious or cosmetic reasons and wish to regain the ability to move their knees.

The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement.

The PROSTALAC functional spacer is made of antibiotic-loaded acrylic cement but has a small metal-on-polythene articular surface. We have used it as an interim spacer in two-stage exchange arthroplasty for infected total knee replacement. PROSTALAC allows continuous rehabilitation between stages as it maintains good alignment and stability of the knee and a reasonable range of movement. It also helps to maintain the soft-tissue planes, which facilitates the second-stage procedure. We reviewed 45 consecutive patients, treated over a period of nine years. The mean follow-up was for 48 months (20 to 112). At final review, there was no evidence of infection in 41 patients (91%); only one had a recurrent infection with the same organism. There was improvement in the Hospital for Special Surgery knee score between stages and at final review. The range of movement was maintained between stages. Complications were primarily related to the extensor mechanism and stability of the knee between stages. Both of these problems decreased with refinement of the design of the implant. The rate of cure of the infection in our patients was similar to that using other methods. Movement of the knee does not appear to hinder control of infection.