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Di Gennaro D, Coletta G, Festa E, De Mauro D, Rizzo M, Diana L, Balato G, Mariconda M. The Effect of Spacer Treatment of Infected Hip and Knee Arthroplasties on Patients' Mental Health: A Narrative Review of the Literature. Healthcare (Basel) 2024; 12:790. [PMID: 38610212 PMCID: PMC11011799 DOI: 10.3390/healthcare12070790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The gold standard treatment for periprosthetic joint infections is the two-stage revision that includes the spacer placement before definitive reimplantation. The management of PJI affects patients' joint function and, subsequently, their mental health. Even though significant advances have been achieved, little to no attention has been paid to the psychological implications. So, based on standardized patient-reported outcome measures (PROMs), this study aimed to clarify the effect of spacer treatment of infected hip and knee arthroplasties on patients' mental health. METHODS We performed research on the literature on PJIs in the English language using the MEDLINE database with the search strings "spacer" OR "spacers" AND "hip" OR "knee" AND "SF-12" OR "SF-36" OR "EQ-5" OR "mental" OR "depression" OR "anxiety." The reference lists of selected articles were also hand-searched for any additional articles. RESULTS A total of 973 published papers were extracted, and 9 papers were finally included. A total of 384 patients who underwent spacer placement for PJI were identified. Of these 384 patients, 54% were female. The mean age ranged from 62 to 78.2 years. Of the11 papers identified for this review, 4 analyzed only hip spacers, including 119 patients; 4 only knee spacers, evaluating 153 patients; while a single study included 112 patients for both joints. CONCLUSIONS Patients with the spacer are living in a state of mental upset, albeit better than the preoperative state. Clinical improvement with the review is not assured. The alteration of mental state turns out not to be transient for all the patients.
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Affiliation(s)
- Donato Di Gennaro
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Giannantonio Coletta
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Enrico Festa
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Domenico De Mauro
- Department of Orthopedics and Geriatric Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Maria Rizzo
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Luca Diana
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Giovanni Balato
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
| | - Massimo Mariconda
- Orthopedic Unit, Department of Public Health, “Federico II” University, 80131 Naples, Italy; (D.D.G.); (G.C.); (E.F.); (M.R.); (L.D.); (M.M.)
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Duncan ST, Schwarzkopf R, Seyler TM, Landy DC. The Practice Patterns of American Association of Hip and Knee Surgeons for the Management of Chronic Periprosthetic Joint Infection After Total Knee Arthroplasty. J Arthroplasty 2023; 38:2441-2446. [PMID: 37142069 DOI: 10.1016/j.arth.2023.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND The management of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) has considerable variation. In order to better capture current preferences for the management of PJI, this study sought to poll the current members of American Association of Hip and Knee Surgeons (AAHKS) first to characterize the distribution of practice patterns. METHODS There were 32 questions in an online survey distributed to members of AAHKS. The questions were multiple choice regarding the management of PJI for TKA. There were 844 out of 2,752 members who completed the survey (response rate of 31%). RESULTS Most of the members were in private practice (50%) compared to 28% being in an academic setting. On average, members were performing between 6 to 20 PJI cases per year. Two-stage exchange arthroplasty was performed in over 75% of the cases with either a cruciate retaining (CR) or posterior stabilized (PS) primary femoral component used in over 50% of the cases and 62% using an all-polyethylene tibial implant. Most of the members were using vancomycin and tobramycin. Typically, 2 to 3 grams of antibiotics were added per bag of cement regardless of the cement type. When indicated, amphotericin was the most often-used antifungal. Post-operative management had major variability with range of motion, brace use, and weight-bearing restrictions. CONCLUSION There was variability in the responses from the members of AAHKS, but there was a preference toward performing a two-stage exchange arthroplasty with an articulating spacer using a metal femoral component and an all-polyethylene liner.
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Affiliation(s)
- Stephen T Duncan
- Department of Orthopedic Surgery, University of Kentucky, Lexington, Kentucky
| | | | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - David C Landy
- Department of Orthopedic Surgery, University of Kentucky, Lexington, Kentucky
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Nace J, Chen Z, Bains SS, Kahan ME, Gilson GA, Mont MA, Delanois RE. 1.5-Stage Versus 2-Stage Exchange Total Hip Arthroplasty for Chronic Periprosthetic Joint Infections: A Comparison of Survivorships, Reinfections, and Patient-Reported Outcomes. J Arthroplasty 2023; 38:S235-S241. [PMID: 36878441 DOI: 10.1016/j.arth.2023.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/18/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Management of periprosthetic joint infection after total hip arthroplasty (THA) has traditionally consisted of a 2-stage approach. However, 1.5-stage exchange has garnered recent interest. We compared 1.5-stage to 2-stage exchange recipients. Specifically, we assessed (1) infection-free survivorship and risk factors for reinfection; (2) 2-year surgical/medical outcomes (eg, reoperations, readmissions); (3) Hip Disability and Osteoarthritis Outcome Scores for Joint Replacement (HOOS-JR); and (4) radiographic outcomes (ie, progressive radiolucent lines, subsidences, and failures). METHODS We reviewed a consecutive series of 1.5-stage or planned 2-stage THAs. A total of 123 hips were included (1.5-stage: n = 54; 2-stage: n = 69) with mean clinical follow-up of 2.5 years (up to 8 years). Bivariate analyses assessed incidences of medical and surgical outcomes. Additionally, HOOS-JR scores and radiographs were evaluated. RESULTS The 1.5-stage exchange had 11% greater infection-free survivorship at final follow-up compared to 2 stages (94% versus 83%, P = .048). Morbid obesity was the only independent risk factor demonstrating increased reinfection among both cohorts. No differences in surgical/medical outcomes were observed between groups (P = .730). HOOS-JR scores improved markedly for both cohorts (1.5-stage difference = 44.3, 2-stage difference = 32.5; P < .001). A total of 82% of 1.5-stage patients did not demonstrate progressive femoral or acetabular radiolucencies, while 94% of 2-stage recipients did not have femoral radiolucencies and 90% did not have acetabular radiolucencies. CONCLUSION The 1.5-stage exchange appeared to be an acceptable treatment alternative for periprosthetic joint infections after THAs with noninferior infection eradication. Therefore, this procedure should be considered by joint surgeons for treatment of periprosthetic hip infections.
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Affiliation(s)
- James Nace
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael E Kahan
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Gregory A Gilson
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- LifeBridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
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Vargas-Vila MA, Siljander MP, Scudday TS, Patel JJ, Barnett SL, Nassif NA. Retained Functional Antibiotic Hip Spacers Have High Rates of Stem Loosening, Subsidence, and Reoperation. J Arthroplasty 2023:S0883-5403(23)00563-6. [PMID: 37257789 DOI: 10.1016/j.arth.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Functional antibiotic hip spacers for treatment of periprosthetic joint infection may be retained in patients deemed too sick for reimplantation, or who elect to forego additional surgery. Our aim was to characterize reoperations, modes of failure, and function outcomes in patients who have retained hip spacers. METHODS We performed a retrospective review of 43 hips (42 patients) who underwent placement of an articulating hip spacer between January 1, 2014 and November 30, 2021 at a single orthopaedic surgical hospital. There were 27 patients (28 hips) who completed 2-stage exchange (TS group) and were reimplanted at mean 4 months (range, 2 to 10). The 15 patients (15 hips) underwent planned spacer retention (RS group). Mean follow-up was 2.9 years (range, 1 to 6.1 years). The RS group was older (74 vs 66 years, P=0.005) and had a higher age-adjusted Charlson Comorbidity Index (4.4 vs 3.3, P=0.04) compared with the TS group. RESULTS Overall survivorship free of reinfection was 91% at 1 year and 86% at 5 years. There were 6 RS hips that underwent reimplantation for spacer failure at a mean of 23 months (range, 6 to 71) months and 8 had radiographic stem loosening / subsidence. Patients who had a retained spacer at final follow-up were more likely to require a walker (P=0.005) or wheelchair (P=0.049) compared with patients who underwent reimplantation. CONCLUSIONS Retained hip spacers can decrease overall surgical burden, but are associated with high rates of stem loosening, subsidence, and unplanned reoperation. Planned spacer retention should be undertaken with caution in patients healthy enough to undergo reimplantation.
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Affiliation(s)
| | | | - Travis S Scudday
- Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA, 92618
| | - Jay J Patel
- Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA, 92618
| | - Steven L Barnett
- Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA, 92618
| | - Nader A Nassif
- Hoag Orthopedic Institute, 16250 Sand Canyon Ave, Irvine, CA, 92618.
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Fiore M, Sambri A, Filippini M, Morante L, Giannini C, Paolucci A, Rondinella C, Zunarelli R, Viale P, De Paolis M. Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis. J Clin Med 2022; 11. [PMID: 36013091 DOI: 10.3390/jcm11164854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The aim of this systematic review is to provide a comprehensive data collection of the results of these different spacers. An in-depth search on the main clinical databases was performed concerning the studies reporting data on the topic. A total of 87 studies and 4250 spacers were included. No significant differences were found both in pooling data analysis and meta-analysis of comparative studies about infection recurrences, complications, and clinical scores. Mean active knee flexion at last follow-up after total knee reimplantation was found to be significantly higher using articulated spacers (91.6° ± 7° for static spacers vs. 100.3° ± 9.9° for articulated spacers; p < 0.001). Meta-analysis also recognized this strong significant difference (p < 0.001). This review has confirmed that articulated spacers do not appear to be inferior to static spacers regarding all clinical outcomes, while they are superior in terms of active flexion. However, the low quality of the studies and the risk for selection bias with complex patients preferentially treated with static spacers need to be accounted for.
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Affiliation(s)
- Thomas K Fehring
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina.,Atrium Musculoskeletal Institute, Charlotte, North Carolina
| | | | | | | | - Jesse E Otero
- OrthoCarolina Hip & Knee Center, Charlotte, North Carolina.,Atrium Musculoskeletal Institute, Charlotte, North Carolina
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Roof MA, Baylor JL, Bernstein JA, Antonelli BJ, Kugelman DN, Egol AJ, Melnic CM, Chen AF, Long WJ, Aggarwal VK, Schwarzkopf R. Comparing the Efficacy of Articulating Spacer Constructs for Knee Periprosthetic Joint Infection Eradication: All-Cement vs Real-Component Spacers. J Arthroplasty 2021; 36:S320-S327. [PMID: 33579629 DOI: 10.1016/j.arth.2021.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/02/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The most common treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a 2-stage revision. Few studies have compared different articulating spacer constructs. This study compares the outcomes of real-component and all-cement articulating spacers for TKA PJI treatment. METHODS This retrospective observational study examined the arthroplasty database at 3 academic hospitals for articulating spacers placed for TKA PJIs between April 2011 and August 2020. Patients were categorized as receiving a real-component or an all-cement articulating spacer. Data on demographics, surgical information, and outcomes were collected. RESULTS One-hundred sixty-four spacers were identified: 72 all-cement and 92 real-component spacers. Patients who received real-component spacers were older (67 ± 10 vs 63 ± 12 years; P = .04) and more likely to be former smokers (50.0% vs 28.6%; P = .02). Real-component spacers had greater range of motion (ROM) after Stage 1 (84° ± 28° vs 58° ± 28°; P < .01) and shorter hospital stays after Stage 1 (5.8 ± 4.3 vs 8.4 ± 6.8 days; P < .01). There was no difference in time to reimplantation, change in ROM from pre-Stage 1 to most recent follow-up, or reinfection. Real-component spacers had shorter hospital stays (3.3 ± 1.7 vs 5.4 ± 4.9 days; P < .01) and operative times during Stage 2 (162.2 ± 47.5 vs 188.0 ± 66.0 minutes; P = .01). CONCLUSION Real-component spacers had improved ROM after Stage 1 and lower blood loss, shorter operative time, and shorter hospital stays after Stage 2 compared to all-cement articulating spacers. The 2 spacer constructs had the same ultimate change in ROM and no difference in reinfection rates, indicating that both articulating spacer types may be safe and effective options for 2-stage revision TKA. LEVEL OF EVIDENCE III, retrospective observational analysis.
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Affiliation(s)
- Mackenzie A Roof
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jessica L Baylor
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jenna A Bernstein
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, New Haven, CT
| | - Brielle J Antonelli
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David N Kugelman
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Alexander J Egol
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Vinay K Aggarwal
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
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Klemt C, Smith EJ, Tirumala V, Bounajem G, van den Kieboom J, Kwon YM. Outcomes and Risk Factors Associated With 2-Stage Reimplantation Requiring an Interim Spacer Exchange for Periprosthetic Joint Infection. J Arthroplasty 2021; 36:1094-1100. [PMID: 33011012 DOI: 10.1016/j.arth.2020.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patients undergoing a 2-stage revision for periprosthetic joint infection (PJI) often require a repeat spacer in the interim due to persistent infection. This study aims to report outcomes for patients with repeat spacer exchange and to identify risk factors associated with interim spacer exchange in 2-stage revision arthroplasty. METHODS A total of 256 consecutive 2-stage revisions for chronic infection of total hip arthroplasty and total knee arthroplasty with reimplantation and minimum 2-year follow-up were investigated. An interim spacer exchange was performed in 49 patients (exchange cohort), and these patients were propensity score matched to 196 patients (nonexchange cohort). Multivariate analysis was performed to analyze risk factors for failure of interim spacer exchange. RESULTS Patients in the propensity score-matched exchange cohort demonstrated a significantly increased reinfection risk compared to patients without interim spacer exchange (24% vs 15%, P = .03). Patients in the propensity score-matched exchange cohort showed significantly lower postoperative scores for 3 patient-reported outcome measures (PROMs): hip disability and osteoarthritis outcome score physical function (46.0 vs 54.9, P = .01); knee disability and osteoarthritis outcome score physical function (43.1 vs 51.7, P < .01); and patient-reported outcomes measurement information system physical function short form (41.6 vs 47.0, P = .03). Multivariate analysis demonstrated Charles Comorbidity Index (odds ratio, 1.56; P = .01) and the presence of Enterococcus species (odds ratio, 1.43; P = .03) as independent risk factors associated with 2-stage reimplantation requiring an interim spacer exchange for periprosthetic joint infection. CONCLUSION This study demonstrates that patients with spacer exchange had a significantly higher risk of reinfection at 2 years of follow-up. Additionally, patients with spacer exchange demonstrated lower postoperative PROM scores and diminished improvement in multiple PROM scores after reimplantation, indicating that an interim spacer exchange in 2-stage revision is associated with worse patient outcomes.
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Affiliation(s)
- Christian Klemt
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Evan J Smith
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Venkatsaiakhil Tirumala
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Georges Bounajem
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Janna van den Kieboom
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
| | - Young-Min Kwon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital Harvard Medical School, Boston, MA
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