[Treatment of infected total knee arthroplasty with a self-made, antibiotic-loaded cement articulating spacer].

OBJECTIVE: To study the efficacy of self-made, antibiotic-loaded cement articulating spacer in the treatment of infected total knee arthroplasty.

METHODS: The self-made molds were used to form the spacer during the operation. From March 2002 to March 2007, 22 patients with infected knee arthroplasty (10 males with 10 knees, 12 females with 12 knees) were treated with this kind of spacer in our center. The mean age of the patients was 59.6 years old (33 to 75 years old). The interval time between primary arthroplasty and first onset of infective syndrome was 6.7 months (1 to 14 months). The diagnosis was established by the clinical presentation,serum laboratory inflammatory markers (white blood cell count,erythrocyte sedimentation rate and C-reactive protein) and knee aspiration. The serum laboratory inflammatory markers were used to measure the systemic response to infection. Clinical and radiographic follow-up was regularly performed by HSS score system and X-ray.

RESULTS: All the patients were followed, the average interval between debridement and reimplantation was 4.7 months (3 to 9 months) and the infection control rate was 100% after the implantation of spacer. The average follow-up duration after reimplantation was 29.8 months (10 to 64 months) and there was no recurrence of infection at the latest follow-up. The HSS score increased from 40.5+/-5.9 to 65.8+/-7.5 after the implantation of spacer, furthermore, the score reached 88.7+/-5.1 in average at the latest follow-up. The patient satisfaction rate was 95.3%.

CONCLUSION: This self-made molds and spacers is a reliable approach for the management of infected knee arthroplasty with some virtues, such as providing a mobile and functional joint through the treatment course, decreasing the difficulty of reimplantation, avoiding of a long-term post-operative infusion and high effective for eradicating infection.