Abstract
The articulating antibiotic spacer is a treatment utilized for two-stage revision
of an infected total knee arthroplasty. The original femoral component is retained
and reused in one described variation of this technique. The purpose of this study
is to determine the safety and efficacy of flash sterilization of the femoral component
for reimplantation in an articulating antibiotic spacer for the treatment of chronic
periprosthetic joint infection. A total of 10 patients were identified prospectively
with a culture positive infected total knee arthroplasty. The patients underwent explantation,
debridement, and placement of an articulating antibiotic spacer consisting of the
explanted and sterilized femoral component and a new polyethylene tibial insert. The
explanted tibial components were cleaned and flash-sterilized with the femoral components,
but the components were then aseptically packaged and sent to our microbiology laboratory
for sonication and culture of the sonicate for 14 days. Ten of 10 cleaned tibial components
were negative for bacterial growth of the infecting organism after final testing and
analysis. At 18-month follow-up, 9 of 10 of patients remained clear of infection.
Among the 10 patients, 7 were pleased with their articulating spacer construct and
had no intention of electively pursuing reimplantation. Also, 3 of 10 of patients
were successfully reimplanted at a mean of 6.5 months after explantation. Autoclave
sterilization and reimplantation of components may be a safe and potentially resource-sparing
method of articulating spacer placement in two-stage treatment of PJI. Patient follow-up
demonstrated clinical eradication of infection in 90% of cases with good patient tolerance
of the antibiotic spacer.
Keywords
flash sterilization - articulating antibiotic spacer - total knee arthroplasty - periprosthetic
joint infection
