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J Knee Surg 2021; 34(10): 1092-1097
DOI: 10.1055/s-0040-1701518
Original Article

Flash Sterilization and Component Reimplantation Is a Viable Option for Articulating Antibiotic Spacers in Periprosthetic Knee Infections

Vasili Karas
1   Chicago Orthopaedics and Sports Medicine, Chicago, Illinois
,
Richard W. Rutherford
2   EmergeOrtho, Durham, North Carolina
,
Thomas A. Herschmiller
3   Olympic Medical Physicians Orthopedic Group, Port Angeles, Washington
,
Johannes F. Plate
4   Wake Forest Baptist Health, Department of Orthopaedic Surgery, Davie Medical Center, North Carolina
,
Michael P. Bolognesi
5   Duke University Medical Center, Department of Orthopaedic Surgery, Durham, North Carolina
,
Maria J. Joyce
6   Department of Medicine, Division of Infectious Disease, Duke, University Medical Center, Durham, North Carolina
,
Samuel S. Wellman
5   Duke University Medical Center, Department of Orthopaedic Surgery, Durham, North Carolina
› Author Affiliations Funding This study was funded by a grant from the Piedmont Orthopedic Society. These funds were used to pay for culture specimen analysis.
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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


Publication History

Received: 19 January 2019

Accepted: 27 December 2019

Article published online:
04 March 2020

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  • References

  • 1 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (8, Suppl): 61-5.e1
    CrossrefPubMedGoogle Scholar
  • 2 Insall JN, Thompson FM, Brause BD. Two-stage reimplantation for the salvage of infected total knee arthroplasty. J Bone Joint Surg Am 1983; 65 (08) 1087-1098
    CrossrefPubMedGoogle Scholar
  • 3 Booth Jr. RE, Lotke PA. The results of spacer block technique in revision of infected total knee arthroplasty. Clin Orthop Relat Res 1989; (248) 57-60
    PubMedGoogle Scholar
  • 4 Fehring TK, Odum S, Calton TF, Mason JB. Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award. Clin Orthop Relat Res 2000; (380) 9-16
    CrossrefPubMedGoogle Scholar
  • 5 Freeman MG, Fehring TK, Odum SM, Fehring K, Griffin WL, Mason JB. Functional advantage of articulating versus static spacers in 2-stage revision for total knee arthroplasty infection. J Arthroplasty 2007; 22 (08) 1116-1121
    CrossrefPubMedGoogle Scholar
  • 6 Hofmann AA, Goldberg T, Tanner AM, Kurtin SM. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res 2005; (430) 125-131
    CrossrefPubMedGoogle Scholar
  • 7 Hofmann AA, Kane KR, Tkach TK, Plaster RL, Camargo MP. Treatment of infected total knee arthroplasty using an articulating spacer. Clin Orthop Relat Res 1995; (321) 45-54
    PubMedGoogle Scholar
  • 8 Smart JD, Belkoff SM, Mears SC. The effectiveness of a program to reduce the rate of flash sterilization. J Arthroplasty 2012; 27 (07) 1267-1270
    CrossrefPubMedGoogle Scholar
  • 9 Bjerkan G, Witsø E, Nor A. et al. A comprehensive microbiological evaluation of fifty-four patients undergoing revision surgery due to prosthetic joint loosening. J Med Microbiol 2012; 61 (Pt 4): 572-581
    CrossrefPubMedGoogle Scholar
  • 10 Larsen LH, Lange J, Xu Y, Schønheyder HC. Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol 2012; 61 (Pt 3): 309-316
    CrossrefPubMedGoogle Scholar
  • 11 Piper KE, Jacobson MJ, Cofield RH. et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol 2009; 47 (06) 1878-1884
    CrossrefPubMedGoogle Scholar
  • 12 Trampuz A, Osmon DR, Hanssen AD, Steckelberg JM, Patel R. Molecular and antibiofilm approaches to prosthetic joint infection. Clin Orthop Relat Res 2003; (414) 69-88
    CrossrefPubMedGoogle Scholar
  • 13 Trampuz A, Piper KE, Hanssen AD. et al. Sonication of explanted prosthetic components in bags for diagnosis of prosthetic joint infection is associated with risk of contamination. J Clin Microbiol 2006; 44 (02) 628-631
    CrossrefPubMedGoogle Scholar
  • 14 Trampuz A, Piper KE, Jacobson MJ. et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 2007; 357 (07) 654-663
    CrossrefPubMedGoogle Scholar
  • 15 Mook WR, Klement MR, Green CL, Hazen KC, Garrigues GE. The Incidence of propionibacterium acnes in open shoulder surgery: a controlled diagnostic study. J Bone Joint Surg Am 2015; 97 (12) 957-963
    CrossrefPubMedGoogle Scholar
  • 16 Lyons ST, Wright CA, Krute CN, Rivera FE, Carroll RK, Shaw LN. Confirming sterility of an autoclaved infected femoral component for use in an articulated antibiotic knee spacer: a pilot study. J Arthroplasty 2016; 31 (01) 245-249
    CrossrefPubMedGoogle Scholar
  • 17 Nagra NS, Hamilton TW, Ganatra S, Murray DW, Pandit H. One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3106-3114
    CrossrefPubMedGoogle Scholar
  • 18 Goltz DE, Sutter EG, Bolognesi MP, Wellman SS. Outcomes of articulating spacers with autoclaved femoral components in total knee arthroplasty infection. J Arthroplasty 2018; 33 (08) 2595-2604
    CrossrefPubMedGoogle Scholar
  • 19 Bjerke-Kroll BT, Christ AB, McLawhorn AS, Sculco PK, Jules-Elysée KM, Sculco TP. Periprosthetic joint infections treated with two-stage revision over 14 years: an evolving microbiology profile. J Arthroplasty 2014; 29 (05) 877-882
    CrossrefPubMedGoogle Scholar
  • 20 Portillo ME, Salvadó M, Alier A. et al. Advantages of sonication fluid culture for the diagnosis of prosthetic joint infection. J Infect 2014; 69 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 21 Fuchs M, Kinzel S, Gwinner C, Perka C, Renz N, von Roth P. Clinically asymptomatic patients show a high bacterial colonization rate of osteosynthetic implants around the knee but not the hip. J Arthroplasty 2019; 34 (08) 1761-1766
    CrossrefPubMedGoogle Scholar
  • 22 Li M, Zeng Y, Wu Y, Si H, Bao X, Shen B. Performance of sequencing assays in diagnosis of prosthetic joint infection: a systematic review and meta-analysis. J Arthroplasty 2019; 34 (07) 1514-1522.e4
    CrossrefPubMedGoogle Scholar