. 2022 Feb 15;7(2):137–152. doi: 10.1530/EOR-21-0037
This work is licensed under a Table 2.
Use of intra-articular spacers in two-stage revision arthroplasty for infected knee arthroplasty.
| Study | Study type | Cases (n) | Mean follow-up (months) | Case group A | Control group B | Group C | Pain/functional outcomes | Impact on second-stage surgery | Mechanical complications (inter-stage) | Eradication rate |
|---|---|---|---|---|---|---|---|---|---|---|
| Chiang et al. (64) | PC | 45 | 40 | Dynamic, moulded (n = 23) | Static, handmade (n = 22) | – | HSS and ROM better with dynamic group | Group B: Increased patella baja and more likely to require extensile approach | Group A: one case of crepitus/pseudolocking (4.3%) | 88.9% NSD |
| Choi et al. (78) | RC | 47 | 58 | Dynamic, mixed, Hoffman-cement/PE articulations (n = 14) | Static, handmade (n = 33) | – | No differences | Grup B: more likely to require extensile approach, more bone loss | – | 68% NSD |
| Classen et al. (91) | CS | 23 | 47 | Dynamic, Hoffman-cement articulation | – | – | – | – | – | 87% |
| Cuckler (92) | CS | 44 | 64.8 | Dynamic, Hoffman-PE articulation | – | – | KSS/ROM: significant improvement inter-stage | No extensile exposures required | – | 97.7% |
| Deboer et al. (90) | RC | 77 | 48 | Dynamic, hybrid moulded PMMA on PE articulation (n = 20) | Dynamic, mixed, preformed/hybrid articulations (n = 57) | – | – | – | 82% NSD | |
| Emerson et al. (89) | RC | 48 | 69.6 | Static, handmade (n = 26) | Dynamic, Hofmann-PE (n = 22) | – | ROM greater for dynamic group | Removal of dynamic components required moderate effort, static spacers associated with more significant bone loss | One subluxed static block (2.1%) | 91.7% NSD |
| Faschingbauer et al. (84) | CS | 133 | n/a | Static, handmade | – | – | – | 14 (10.5%): 12 periprosthetic fractures (9.1%), 1 spacer fracture (0.8%), 1 subluxed patella (0.8%) | 88% | |
| Fehring et al. (75) | RC | 40 | 31 | Static, handmade (n = 25) | Dynamic, moulded (n = 30) | – | HSS & ROM: Good in both groups, no significant difference | Significant bone loss seen static spacers, sometimes requiring augmentation | Subluxation of static spacers seen | 90% NSD |
| Freeman et al. (93) | RC | 76 | 71.2 | Static, handmade (n = 28) | Dynamic, moulded (n = 48) | – | KSS: Group A: fair-good. Group B: good-excellent. No significant differences | – | – | 93.9% NSD |
| Goldman et al. (94) | CS | 64 | <48 | Static, handmade (n = 7) | No spacer (n = 57) | – | – | Easier exposure with spacer | – | NSD |
| Gomez et al. (85) | RC | 326 | 59.7 | Static, handmade (n = 226) | Dynamic, moulded (n = 100) | – | – | – | 10 dislocations (3.1%), 1 fracture (0.3%) | 81.4% |
| Gooding et al. (47) | CS | 115 | 108 | Dynamic, PROSTALAC | – | – | WOMAC, SF-12 (mental) & OKS: significant improvement | – | Two dislocations (1.7%), two spacer fractures (1.7%) | 88% |
| Haleem et al. (95) | CS | 96 | 86.4 | Static | – | – | KSS & ROM: significant improvement | – | – | 85% at 10 years |
| Hart & Jones (96) | CS | 48 | 48.5 | Dynamic, moulded | – | – | ROM: Good | – | Two spacer dislocations (4.2%) | 87.5% |
| Hirakawa et al. (97) | CS | 55 | 61.9 | Static | – | – | – | – | – | 74.5% |
| Hsu et al. (79) | RC | 28 | 68.8 | Static, handmade (n = 7) | Dynamic, moulded (n = 21) | – | KSS & ROM: Significantly better in dynamic group | Group B: Fewer extensile exposures and less bone loss | Group B: one subluxed spacer (3.6%) | 85.7% NSD |
| Jämsen et al. (98) | RC | 34 | 32 | Dynamic, Hoffman-PE articulation (n = 24). | Static, handmade (n = 10). | – | KSS ROM: better in dynamic group. | Group B: More blood loss & longer procedure. | Five subluxed spacers (14.7%). | 88% NSD |
| Johnson et al. (76) | RC | 115 | 27 | Mixed: Dynamic, moulded, preformed, PROSTALAC (n = 34) | Static, handmade (n = 81) | – | KSS & ROM: no significant difference | Group B: More bone loss | (3.5%); four dynamic spacer fractures (11.8%) | 82.6% NSD |
| Juul et al. (99) | CS | 22 | 37.6 | Dynamic, CUMARS | – | – | AKSS & ROM: Good | – | – | 82% |
| Kotwal et al. (100) | CS | 58 | 29.4 | Static, handmade | – | – | – | Bone loss improved by the use of an intramedullary rod | Mechanical complications reduced by the use of intramedullary rod | 83.8% |
| Nahhas 2020 (69) | RT | 49 | 42 | Static, handmade (n = 24) | Dynamic, moulded (n = 25) | –– | Length of stay, KSS & ROM: better in dynamic group | More extensile approaches needed for static group | One spacer fracture (static) | 93.9% |
| Nodzo et al. (101) | RC | 140 | 59 | Dynamic, preformed (n = 58) | Dynamic, moulded (n = 43) | Dynamic, Hofmann-PMMA (n = 39) | – | – | – | 83.6% NSD |
| Park et al. (77) | RC | 36 | 36 | Static, handmade (n = 20) | Dynamic, moulded (n = 16) | – | HSS, KSS & ROM: better in dynamic group. Extensor lag seen in static group | Group A: More bone loss | – | 88.9% NSD |
| Tian et al. (102) | CS | 25 | 64.2 | Dynamic, moulded | – | – | Pain, KSS & ROM: Good-excellent | 13 cases (52%) required extensile exposure | Five dislocations, one spacer fracture | 100% |
| Van Thiel et al. (103) | CS | 60 | 35 | Dynamic, moulded | – | – | KSS & ROM: Good | No bone loss seen | One spacer fracture | 88% |
AKSS, American Knee Society Score; CS, case series; HSS, Hospital of Special Surgery; KSS, Knee Society Score; NSD, no significant difference; OKS, Oxford Knee Score; PC, prospective cohort; RC, retrospective cohort; RT, randomised trial; ROM, range of motion; SF-12, 12-item Short Form Survey; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index.