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PurposeSeptic arthritis of the native joint is challenging for orthopedic surgeons because it may lead to wide bone defects and severe impairment of joint function. This study aimed to analyze clinical functional outcomes, the rate of infection eradication, and survival of implants of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee.MethodsA retrospective single-centre analysis was conducted of patients treated for septic arthritis of the hip and knee joints through a two-stage surgery between 2012 and 2015. Clinical and radiological records were gathered from the prospectively collected Institutional Arthroplasty Registry. Patients’ pre-operative Harris hip scores and Knee Society scores were compared with those obtained at the latest follow-up. Kaplan–Meier curves were generated to assess survival of implants.ResultsForty-seven patients were included. The mean follow-up was 85.2 ± 15.4 months. The Harris hip score improved from 39.4 ± 9.9 to 84.5 ± 10.8 points (p< 0.001). The Knee Society score improved from 40.7 ± 8.4 to 86.0 ± 7.8 points (p< 0.001). Knee Society score-function increased from 25.7 ± 14.2 to 85.4 ± 23.4 points (p< 0.001). The infection eradication rates were 92.0% and 90.9% in patients who underwent hip and knee operation, respectively (p= 0.891). Overall survivorship of implants after the second stage was 93.6%.ConclusionsTwo-stage arthroplasty provides good to excellent clinical outcomes in cases of active septic arthritis of the hip and the knee, high rates of infection control, and implant survival.

We describe an inexpensive method of producing a reinforced articulating cement spacer using a commercially available hip cement mould. We have a cohort of 15 consecutive patients in whom this novel cement spacer has been used. All patients were able to at least partially weight bear and none of the spacers fractured. Thirteen have been explanted at second stage operation after a minimum of eight weeks in situ. Two patients have been unable to undergo a second stage due to unrelated death and medical problems precluding further surgery. The articulating cement spacer described is produced using a technique that is simple, reproducible and allows a reinforced spacer to be created inexpensively without the need for special equipment.

We reviewed the current use of spacers in the management of the infected knee prosthesis. There are two types of temporary spacers: block or non-articulating spacers and articulating or mobile spacers. Generally, spacers improve mobilisation and hasten recovery with shorter hospital stay between stages. Furthermore, spacers facilitate the second-stage procedure by maintaining joint space, and articulating spacers may also maintain range of motion. Last but not the least, the cost of spacers represents only a small fraction of the total expenses for management of infected knee arthroplasties.

Periprosthetic infection after total hip arthroplasty is a devastating complication. A two-stage protocol with the temporary insertion of an antibiotic-laden cement spacer is the gold standard treatment for chronic infections (Clinics (Sao Paulo) 62:99–108, 2007; Clin Orthop Relat Res 427:37–46, 2004; J Arthroplast 14:175–181, 1999; Clin Orthop Relat Res 467:1848–1858, 2009; J Arthroplast 20:874–879, 2005; J Arthroplast 24: 607–613, 2009; Clin Orthop Relat Res 469:1009–1015, 2011; Hip Int 20:26–33, 2010; J Arthroplast 24:1051–1060, 2009; J Bone Joint Surg Br 91:44–51, 2009). Some authors, however (Int J Med Sci 6(5):265–73, 2009), report mechanical complication rates with spacers in excess of 50 %.Therefore, the aim of this study is to determine (1) the mechanical complications associated with enclosed articulating partial load-bearing spacers when treating periprosthetic hip infections and (2) possible factors of influence. Between 2000 and 2011, 138 patients received an antibiotic-laden cement spacer as part of a two-stage protocol. The overall frequency of complications (spacer fracture, dislocation, femoral fracture with enclosed spacer, spacer fracture with dislocation, protusion into the pelvis) was recorded. Potential influencing factors (‘mould spacer’ vs. handmade spacer, Steinmann pins as an endoskeleton, addition of vancomycin into the spacer) were analysed. The mean age at the time of the first stage operation was 69.3 ± 10.5 years. Overall, 27 of 138 patients suffered one of the above-mentioned complications (19.6 %). Spacer fracture occurred in 12 cases (8.7 %) and dislocation in another 12 (8.7 %). There was also one periprosthetic femoral fracture with a spacer in situ, one dislocation with a simultaneous spacer fracture, and one protrusion into the pelvis (0.7 % each). Our data revealed an overall complication rate of 13.2 % with a mould spacer enclosing a Steinman pin. The mechanical complication rate of over 50 % reported by some authors cannot be confirmed. As a consequence, we recommend using a mould spacer with an enclosed Steinman pin as an endoskeleton to minimize the complication rate.

Two-stage revision represents the gold standard in the treatment of infected total knee arthroplasty. Different techniques have been proposed, mostly not preserving range of motion. An articulated antibiotic-loaded cement spacer made in association with two unicompartmental implants has been used as an alternative to a static spacer in an effort to retain as much movement as possible between the stages in young, high-demand patients with preserved ROM.We evaluated nine consecutive patients with a mean age of 66.5 years. The second stage was performed after lab tests returned to normal and culture proved negative. Mean follow-up was 4.6 years.Mean ROM from a preoperative value of 105.6° was 103.5° after the first stage, and improved to 110.0° after the definitive implant. Mean Knee Society score was 27.6 preoperatively improving to 86.4 points postoperatively. WOMAC score showed that six patients were very satisfied with the overall result of their reimplanted knee, three subjects were somewhat satisfied. No recurrence of infection, no significant radiolucent lines or osteolysis were recorded at clinical and radiological follow-up and the patients were satisfied with the outcome.Results indicated that this technique may ensure the advantages of a static spacer, but allow a greater ROM and better functional recovery. It may be considered as a viable option in selected cases even though the higher costs of two unicompartmental implants should be considered in the light of other aspects, such as prolonged hospital stay and rehabilitation in revision of infected total knee arthroplasty.