Comparing the Efficacy of Articulating Spacers in Two-Stage Revision for Periprosthetic Joint Infection Following Total Knee Arthroplasty: All-Cement Spacers vs Sterilized Replanted Metal-Polyethylene Spacers

Zhixuan Fei,1,2 Zian Zhang,1 Yingzhen Wang,1 Haining Zhang,1 Shuai Xiang1 1Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China; 2Qingdao University, Medical Department, Qingdao, People’s Republic of ChinaCorrespondence: Shuai Xiang, Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, People’s Republic of China, Email 15169093669@163.comPurpose: Two-stage revision is the most common treatment for periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). Few studies have compared the clinical efficacy of different articulating spacers. This study compared the outcomes of all-cement articulating spacers and sterilized replanted metal-polyethylene articulating spacers for PJI following TKA.Patients and Methods: In this retrospective observational study, 47 patients who received two-stage revision for PJI following TKA between 2006 and 2020 in our hospital were included. Patients were categorized as receiving an all-cement articulating spacer or a sterilized replanted metal-polyethylene articulating spacer in exclusion. Data on demographics, surgical information, and outcomes were collected in 2021.Results: Forty-seven spacers were identified: all-cement spacer was noted in 23 patients and sterilized replanted spacer in 24. Patients in the all-cement spacer group had shorter operation time (155.87 ± 33.12 vs 189.79 ± 51.21 min; P = 0.0102) and less blood loss (845.22 ± 525.92 vs 1114.50 ± 547.81 mL; P = 0.0427) in exclusion. Patients in the sterilized replanted spacer group had superior interval range of motion (ROM; 61.00 ± 31.94° vs 31.75 ± 33.38°; P = 0.0072), postoperative ROM (85.00 ± 11.11° vs 77.37 ± 9.18°; P = 0.0329) as compared to all-cement spacers, but there was no difference in infection control between 2 groups.Conclusion: The two types of spacers had no difference in the reinfection rate, indicating that both articulating spacers are safe and effective for 2-stage revision. Considering ROM of knee joint, bone loss and cost, sterilized replanted metal-polyethylene spacers are preferred in the treatment of PJI.Keywords: total knee arthroplasty, periprosthetic joint infection, articulating spacer