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  • Title: Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients.
    Author: Villanueva-Martínez M, Ríos-Luna A, Pereiro J, Fahandez-Saddi H, Villamor A.
    Journal: Acta Orthop; 2008 Oct; 79(5):674-82. PubMed ID: 18839375.
    Abstract:
    BACKGROUND AND PURPOSE: The most reliable results when treating an infected total knee arthroplasty have been obtained with a two-stage reimplantation protocol. We have used a simple technique for hand-made spacers and now report the outcome. PATIENTS AND METHODS: 30 patients with an infected total knee arthroplasty (TKA) were treated with a 2- stage reimplantation protocol. Spacers were built and customized to the type of defect using only 2 retractors and a high-speed tip burr. Partial weight bearing and discharge from the hospital were encouraged in the time between surgeries. 29 of 30 patients (97%) had successful reimplantations and they were followed for an average of 3 (2-5) years. RESULTS: Range of motion with the articulating spacer averaged 80 degrees (55-100) and 21 of the 30 patients achieved motion greater than 75 degrees . At the latest follow-up, there were no reinfections. According to the Knee Society score (KSS), the results were considered excellent or good in 25 patients, and fair or poor in 4 of the 29 patients with reimplantations. Motion after reimplantation averaged 107 degrees (90-120). INTERPRETATION: One of the key factors related to a successful outcome with a two-stage reimplantation procedure is to keep the joint mobile and functional in the time between surgeries. Hand-made articulating spacers retain most of the advantages of more complex spacers in terms of mobility, pain, bone loss, success, or re-infection rate-with the major advantages of price and universal availability. Limitations related to this technique include potential knee instability, the need to walk with an orthosis, and the risk of subluxations.
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