SYMPOSIUM: PERIPROSTHETIC JOINT INFECTION
Intraoperative Molds to Create an Articulating Spacer
for the Infected Knee Arthroplasty
Geoffrey S. Van Thiel MD, MBA, Keith R. Berend MD,
Gregg R. Klein MD, Alexander C. Gordon MD,
Adolph V. Lombardi MD, Craig J. Della Valle MD
Published online: 2 November 2010
? The Association of Bone and Joint Surgeons1 2010
ditionally treated with a two-stage protocol incorporating a
temporary antibiotic-loaded cement spacer. The use of a
static as opposed to an articulating spacer is controversial.
Some surgeons believe a static spacer results in a higher
rate of infection eradication, whereas others believe an
articulating spacer provides equivalent rates of infection
control with improved function between stages and the
potential for better eventual range of motion.
Chronic infections in TKA have been tra-
control and postoperative function for an articulating all-
cement antibiotic spacer fashioned intraoperatively from
prefabricated silicone molds.
We retrospectively reviewed 60 patients with an
infected TKA using the same cement-on-cement articu-
lating spacer. A minimum of 4 g antibiotic per package of
cement was used when making the spacer. Complications
and pre- and postoperative knee flexion, extension, and
Knee Society scores were recorded. Bone loss associated
with the spacer was determined radiographically and
by intraoperative inspection of the bony surfaces at the
second stage. Minimum followup was 24 months (mean,
35 months; range, 24–51 months).
Seven patients (12%) became reinfected, four
with an organism different from that identified at the index
resection arthroplasty. One spacer femoral component
broke between stages but did not require any specific
treatment. We identified no bone loss between stages and
no complications related to the cement-on-cement articu-
lation. The mean pretreatment Knee Society scores of 53
improved to 79. The mean preoperative flexion of 90.68
improved to 101.38 at final followup.
An articulating antibiotic spacer was asso-
ciated with control of a deep periprosthetic infection in
88% of patients while allowing range of motion between
We determined the rates of infection
One of the authors (KRB) is a consultant for and has received research
support and royalties for intellectual property from Biomet, Inc
(Warsaw, IN) andisa consultant forSynvasive(Reno, NV)andSalient
Surgical (Portsmouth, NH). One of the authors (GRK) is a consultant
for Biomet. One of the authors (ACG) is a consultant for Biomet,
Wright Medical Technology, Inc (Arlington, TN), DePuy
Orthopaedics, Inc (Warsaw, IN), and BrainLab (Westchester, IL). One
of the authors (AVL) is a consultant for and has received research
support and royalties for intellectual property from Biomet and has
received royalties from Innomed (Savannah, GA). One of the authors
(CJDV) is a consultant for Biomet, Kinamed (Camarillo, CA), Smith
and is on the advisory board for CD Diagnostics (Philadelphia, PA).
They have also received research support from Zimmer (Warsaw, IN).
Each author certifies that his or her institution approved the human
protocolforthisinvestigation, thatallinvestigations were conductedin
conformity with ethical principles of research, and that informed
consent for participation in this study was not required.
Study data collected at Rush University Medical Center, Chicago, IL;
Joint Implant Surgeons, New Albany, OH; and Hartzband Center for
Hip and Knee Replacement, Paramus, NJ.
G. S. Van Thiel, C. J. Della Valle (&)
Rush University Medical Center, 1611 West Harrison Street,
Suite 300, Chicago, IL 60612, USA
K. R. Berend, A. V. Lombardi
Joint Implant Surgeons, New Albany, OH, USA
G. R. Klein
Hartzband Center for Hip and Knee Replacement,
Paramus, NJ, USA
A. C. Gordon
Illinois Bone and Joint Institute, Chicago, IL, USA
Clin Orthop Relat Res (2011) 469:994–1001
15. Huang HT, Su JY, Chen SK. The results of articulating spacer
technique for infected total knee arthroplasty. J Arthroplasty.
16. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee
17. Insall JN, Thompson FM, Brause BD. Two-stage reimplantation
for the salvage of infected total knee arthroplasty. J Bone Joint
Surg Am. 1983;65:1087–1098.
18. Jacobs C, Christensen CP, Berend ME. Static and mobile
antibiotic-impregnated cement spacers for the management of pros-
thetic joint infection. J Am Acad Orthop Surg. 2009;17:356–368.
19. Jamsen E, Sheng P, Halonen P, Lehto MU, Moilanen T, Pajamaki
J, Puolakka T, Konttinen YT. Spacer prostheses in two-stage
revision of infected knee arthroplasty. Int Orthop. 2006;30:
20. Jamsen E, Stogiannidis I, Malmivaara A, Pajamaki J, Puolakka T,
Konttinen YT. Outcome of prosthesis exchange for infected knee
Clin OrthopRelat Res.
arthroplasty: the effect of treatment approach. Acta Orthop.
21. McPherson EJ, Lewonowski K, Dorr LD. Techniques in
arthroplasty. Use of an articulated PMMA spacer in the infected
total knee arthroplasty. J Arthroplasty. 1995;10:87–89.
22. Meek RM, Masri BA, Dunlop D, Garbuz DS, Greidanus NV,
McGraw R, Duncan CP. Patient satisfaction and functional status
after treatment of infection at the site of a total knee arthroplasty
with use of the PROSTALAC articulating spacer. J Bone Joint
Surg Am. 2003;85:1888–1892.
23. Pitto RP, Castelli CC, Ferrari R, Munro J. Pre-formed articulating
knee spacer in two-stage revision for the infected total knee
arthroplasty. Int Orthop. 2005;29:305–308.
24. Whaley AL, Trousdale RT, Rand JA, Hanssen AD. Cemented
long-stem revision total knee arthroplasty. J Arthroplasty. 2003;
25. Wilde AH, Ruth JT. Two-stage reimplantation in infected total
knee arthroplasty. Clin Orthop Relat Res. 1988;236:23–35.
Volume 469, Number 4, April 2011 Antibiotic Spacers for Infected TKA1001