- 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.
MetadatenAuthor: | Kristoff Hammerich, Jens Pollack, Alexander F. Hasse, André El-SamanORCiDGND, René HuberORCiDGND, Markus Rupp, Volker Alt, Raimund W. KinneORCiDGND, Jörg Mika |
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URN: | urn:nbn:de:hebis:30:3-621511 |
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DOI: | https://doi.org/10.3390/jcm10050971 |
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ISSN: | 2077-0383 |
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Parent Title (English): | Journal of Clinical Medicine |
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Publisher: | MDPI |
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Place of publication: | Basel |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2021/03/02 |
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Date of first Publication: | 2021/03/02 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2021/10/19 |
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Tag: | (sub-) luxation; cost-effective; dislocation; intraoperatively molded; inverse spacer; revision knee arthroplasty |
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Volume: | 10 |
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Issue: | 5, art. 971 |
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Page Number: | 9 |
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First Page: | 1 |
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Last Page: | 9 |
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Note: | This research received no external funding. We acknowledge publication support by the German Research Foundation (DFG) and the Open Access Publication Fund of Hannover Medical School (MHH). |
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HeBIS-PPN: | 488124646 |
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Institutes: | Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - Namensnennung 4.0 |
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