The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty
Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/5/971 |
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| author | Kristoff Hammerich Jens Pollack Alexander F. Hasse André El Saman René Huber Markus Rupp Volker Alt Raimund W. Kinne Joerg Mika |
| author_facet | Kristoff Hammerich Jens Pollack Alexander F. Hasse André El Saman René Huber Markus Rupp Volker Alt Raimund W. Kinne Joerg Mika |
| author_sort | Kristoff Hammerich |
| collection | DOAJ |
| description | Background: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery. |
| first_indexed | 2024-03-09T06:01:55Z |
| format | Article |
| id | doaj.art-0a29367d918349afbdd4447e2ae6ab75 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T06:01:55Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-0a29367d918349afbdd4447e2ae6ab752023-12-03T12:07:44ZengMDPI AGJournal of Clinical Medicine2077-03832021-03-0110597110.3390/jcm10050971The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee ArthroplastyKristoff Hammerich0Jens Pollack1Alexander F. Hasse2André El Saman3René Huber4Markus Rupp5Volker Alt6Raimund W. Kinne7Joerg Mika8Department of Orthopaedic Surgery, Eichsfeld Klinikum gGmbH, Academic Teaching Hospital of the University of Goettingen, 37308 Heilbad Heiligenstadt, GermanyDepartment of Orthopaedic Surgery, SRH Wald-Klinikum Gera, Academic Teaching Hospital of the University of Jena, 07548 Gera, GermanyDepartment of Internal Medicine 1, Section of Hematology/Oncology/Rheumatology, University Hospital Homburg, 66421 Homburg, GermanyDepartment of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, 60590 Frankfurt am Main, GermanyExperimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, GermanyDepartment of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, GermanyDepartment of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, GermanyExperimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, GermanyExperimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, GermanyBackground: A major disadvantage of current spacers for two-stage revision total knee arthroplasty (R-TKA) is the risk of (sub-) luxation during mobilization in the prosthesis-free interval, limiting their clinical success with detrimental consequences for the patient. The present study introduces a novel inverse spacer, which prevents major complications, such as spacer (sub-) luxations and/or fractures of spacer or bone. Methods: The hand-made inverse spacer consisted of convex tibial and concave femoral components of polymethylmethacrylate bone cement and was intra-operatively molded under maximum longitudinal tension in 5° flexion and 5° valgus position. Both components were equipped with a stem for rotational stability. This spacer was implanted during an R-TKA in 110 knees with diagnosed or suspected periprosthetic infection. Postoperative therapy included a straight leg brace and physiotherapist-guided, crutch-supported mobilization with full sole contact. X-rays were taken before and after prosthesis removal and re-implantation. Results: None of the patients experienced (sub-) luxations/fractures of the spacer, periprosthetic fractures, or soft tissue compromise requiring reoperation. All patients were successfully re-implanted after a prosthesis-free interval of 8 weeks, except for three patients requiring an early exchange of the spacer due to persisting infection. In these cases, the prosthetic-free interval was prolonged for one week. Conclusion: The inverse spacer in conjunction with our routine procedure is a safe and cost-effective alternative to other articulating or static spacers, and allows crutch-supported sole contact mobilization without major post-operative complications. Maximum longitudinal intra-operative tension in 5° flexion and 5° valgus position appears crucial for the success of surgery.https://www.mdpi.com/2077-0383/10/5/971inverse spacerintraoperatively moldedcost-effective(sub-) luxationdislocationrevision knee arthroplasty |
| spellingShingle | Kristoff Hammerich Jens Pollack Alexander F. Hasse André El Saman René Huber Markus Rupp Volker Alt Raimund W. Kinne Joerg Mika The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty Journal of Clinical Medicine inverse spacer intraoperatively molded cost-effective (sub-) luxation dislocation revision knee arthroplasty |
| title | The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty |
| title_full | The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty |
| title_fullStr | The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty |
| title_full_unstemmed | The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty |
| title_short | The Inverse Spacer—A Novel, Safe, and Cost-Effective Approach in Routine Procedures for Revision Knee Arthroplasty |
| title_sort | inverse spacer a novel safe and cost effective approach in routine procedures for revision knee arthroplasty |
| topic | inverse spacer intraoperatively molded cost-effective (sub-) luxation dislocation revision knee arthroplasty |
| url | https://www.mdpi.com/2077-0383/10/5/971 |
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