Articulating vs. Static antibiotic impregnated spacers in revision total knee arthroplasty for sepsis. A systematic review

Abstract

Periprosthetic infection after total knee arthroplasty is a devastating complication, and two-stage exchange is the standard of care in North America. Articulating and static spacers have been developed to treat these infections but controversy exists over which method is superior. We performed a systematic review using MEDLINE and other literature search engines identifying 47 articles meeting inclusion criteria producing 2011 spacers for comparison. Articulating spacers had increased range of motion 100.1° vs. 82.9° (P<0.003), lower re-infection rate 7.5% (P<0.0031), facilitated re-implantation (P<0.0011), and developed less bone loss (P<.0001) than did static spacers. This study answers several clinically relevant questions and provides useful information in guiding clinical decision making in treating periprosthetic infection.

Keywords: infection; total knee arthroplasty; two-stage exchange.