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Archives of Orthopaedic and Trauma Surgery

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09-05-2023 | Joint Infection | Knee Revision Surgery

Indications and techniques for non-articulating spacers in massive bone loss following prosthetic knee joint infection: a scoping review

Authors: Jonas P. Sina, Shiraz A. Sabah, Daniel Schrednitzki, Andrew J. Price, Thomas W. Hamilton, Abtin Alvand

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 9/2023

Abstract

Introduction

Prosthetic joint infection (PJI) is a destructive complication of knee replacement surgery (KR). In two-stage revision a spacer is required to maintain limb length and alignment and provide a stable limb on which to mobilise. Spacers may be articulating or static with the gold standard spacer yet to be defined. The aims of this scoping review were to summarise the types of static spacer used to treat PJI after KR, their indications for use and early complication rates.

Methods

We conducted a scoping review based on the Joanna Briggs Institute’s “JBI Manual for Evidence Synthesis” Scoping review reported following Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. MEDLINE, EMBASE and CINAHL were searched from 2005 to 2022 for studies on the use of static spacers for PJI after KR.

Results

41 studies (1230 patients/knees) were identified describing 42 static spacer constructs. Twenty-three (23/42 [54.2%]) incorporated cement augmented with metalwork, while nineteen (19/42, [45.9%]) were made of cement alone. Spacers were most frequently anchored in the diaphysis (22/42, [53.3%]), particularly in the setting of extensive bone loss (mean AORI Type = F3/T3; 11/15 studies 78.3% diaphyseal anchoring). 7.1% (79 of 1117 knees) of static spacers had a complication requiring further surgery prior to planned second stage with the most common complication being infection (86.1%).

Conclusions

This study has summarised the large variety in static spacer constructs used for staged revision KR for PJI. Static spacers were associated with a high risk of complications and further work in this area is required to improve the quality of care in this vulnerable group.

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Title: Indications and techniques for non-articulating spacers in massive bone loss following prosthetic knee joint infection: a scoping review
Authors: Jonas P. Sina
Shiraz A. Sabah
Daniel Schrednitzki
Andrew J. Price
Thomas W. Hamilton
Abtin Alvand
Publication date: 09-05-2023
Publisher: Springer Berlin Heidelberg
Keyword: Joint Infection
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 9/2023
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-023-04893-z

At a glance: The STEP trials

Springer Medicine

Indications and techniques for non-articulating spacers in massive bone loss following prosthetic knee joint infection: a scoping review

Abstract

Introduction

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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