The Effect of Time Spent with a Dynamic Spacer on Clinical and Functional Outcomes in Two-Stage Revision Knee Arthroplas
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ORIGINAL ARTICLE
The Effect of Time Spent with a Dynamic Spacer on Clinical and Functional Outcomes in Two‑Stage Revision Knee Arthroplasty Fatih Golgelioglu1 · Sinan Oguzkaya2 · Abdulhamit Misir3 · Ahmet Guney4 Received: 30 May 2020 / Accepted: 24 August 2020 / Published online: 2 September 2020 © Indian Orthopaedics Association 2020
Abstract Introduction The present study aimed to evaluate the effect of a longer interval between the first and second stages of infected total knee arthroplasty (TKA) revision on the clinical and functional outcome. Methods This study included a total of 56 patients who underwent two-stage revision TKA with a dynamic spacer with a minimum of 2 years of follow-up. Patients were categorized into two groups according to time with the spacer: 3 months (Group 2, 25 patients). Clinical outcome and quality of life were assessed by knee range of motion (ROM), Knee Society Score for Knee (KSS-K), Knee Society Score for Function (KSS-F) and Short Form 36 (SF-36). Results The mean follow-up period was 48 ± 19.1 months (range, 24–84 months). The KSS-K, KSS-F, and ROM values were significantly higher in Group 1 than in Group 2 (p 0.05). The mean CRP values before the second stage was 7.6 ± 3.4 mg/L in Group 1 and 7.9 ± 5.4 mg/L in Group 2 (p = 0.76).There was also no difference in terms of duration of IV antibiotics between two stages (Group 1: 7.1 ± 1.3 weeks, Group 2: 7.3 ± 1.6 weeks p = 0.87).
Group 1 had significantly better postoperative KSSKnee and KSS-Function scores (p = 0.016 and p = 0.014, respectively) (Table 3). Further, general health, bodily pain, and physical function domains of the SF-36 score were significantly higher in Group 1 (p 0.05). Infection-free survival times of each group was similar (Group 1:72.40 ± 4.90 vs. Group 2:71.28 ± 4.92 p = 0.920) (Fig. 4). Six patients with reinfections were treated with two-stage revision. Three patients underwent knee arthrodesis, and above-knee
Table 1 Patient characteristics
Gender Side Age BMI Spacer time (Day) Follow-up time (Month) Comorbidity
Table 2 Causing microorganism in both groups
13
Female Male Right Left
Diabetes mellitus Hypertension Malignancy Cerebrovascular disease Chronic renal failure Morbid obesity Chronic obstructive lung disease Coronary artery disease
Group 1 (N = 31)
Group 2 (N = 25)
p
17 (54.8%) 14 (45.2%) 16 (51.6%) 15 (48.4%) 66.3 ± 8.6 29.2 ± 4.2 72.6 ± 8.8 48.6 ± 19.1 9 (%29) 16 (%51.6) 2 (%6.4) 1 (%3.2) 2 (%6.4) 3 (%9.6) 6 (%19.3) 4 (%12.9)
18 (72.0%) 7 (28.0%) 14 (56,0%) 11 (44.0%) 67.8 ± 9.2 28.9 ± 4.8 166.7 ± 60.6 47.1 ± 17.2 11 (%44) 14 (%56) 1 (%4) 2 (%8) 3 (%12) 3 (%12) 4 (%16) 3 (%12)
0.192 0.580 0.355 0.624 0.010 0.768 0.729 0.844 0.803 0.820 0.625 1.000 0.641 0.757
Microorganism
Group 1 n (%)
Group 2 n (%)
p value
Total n (%)
Coagulase-negative Staphylococcus S.aureus S. agalactia Enterococcus MRSA Pseudomonas auriginosa Mix organisms Culture negative
10 (32.2%) 4 (12.9%) 2 (6.4%) 2 (6.4%) 5 (16.1%) 2 (6.4%) 3 (9.6%) 4 (12.9%)
8 (32%) 3 (12%) 2 (8%) 1 (4%) 4 (16%) 1 (4%)
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