Application of an articulating spacer in two-stage revision for severe infection after total knee arthroplasty

Objective: To investigate the efficiency and safety of articulating spacer for severe infection after total knee arthroplasty (TKA) in patients with medical comorbidities and local sinus tracts. Methods: Between January 2002 and March 2008, ten consecutive patients with late stage infected TKA complicated by local sinus tracts and medical comorbidities, were treated in our hospital by delayed two-stage reimplantation using articulating spacers. The modified Hospital for Special Surgery (HSS) knee scoring system was used to evaluate the results. Results: One patient underwent knee fusion as the infection could not be controlled after first-stage surgery. Infection was eradicated in the other nine patients. The mean follow-up was 50 months (range, 24–90 months), no recurrent infection developing in these nine patients. The average modified HSS score was 48 points (range, 32–63) before the first-stage surgery, 79 points (range, 62–91) at the end of the spacer period, and 89 points (range, 74–95) at the latest follow-up, and the good to excellent rate was 0%, 80% and 100%, respectively. The average range of motion had improved to 8° to 93° at the end of the spacer period, and 3° to 110° at the last follow-up, compared to 13° to 70° preoperatively. Conclusion: Delayed two-stage reimplantation using an articulating spacer is effective for treating infected TKA in patients with medical comorbidities or local sinuses.