Clinical Evaluation of Two-Stage Revision Total Knee Arthroplasty Using Silicone Mold-Based and Metal Mold-Based Antibiotic-Loaded Knee Spacers: A Comparative Study.

BACKGROUND

The gold standard for managing infection following total knee arthroplasty (TKA) is two-stage revision surgery, which entails the placement of a spacer in the knee during the initial stage. This study aimed to compare metal mold-based and silicone mold-based spacers regarding clinical evaluation and infection control in patients with infected TKAs.

METHODS

In this study, we assigned fourteen individuals with infected knees following arthroplasty to either the metal mold-based spacer group (control) or the silicon mold-based spacer group. The WOMAC Score, Knee Society Score (KSS), and range of motion (ROM) were utilized for clinical evaluation prior to spacer implantation and during the post-first stage of surgery follow-up. Gain score analysis (post-pre difference) was conducted to assess functional improvement over time. The Wilcoxon signed-rank test and the Mann-Whitney U test were applied for statistical analysis using SPSS software.

RESULTS

Knee infection was eliminated in all participants across both groups. Post-surgery, ROM improved from 59.28 ± 20.29° to 99.00 ± 5.65° in the control group, while the intervention group demonstrated an increase in ROM from 66.42 ± 24.78° to 101.42 ± 8.01°. Additionally, the KSS improved from 38.28 ± 23.78 to 123.71 ± 20.53 in the control group and from 35.71 ± 30.99 to 124.85 ± 27.49 in the intervention group. The WOMAC score increased from 48.71 ± 9.23 to 70.57 ± 5.28 in the control group and from 47.71 ± 12.03 to 72.57 ± 6.32 in the intervention group. There were no statistically significant differences between the two groups in terms of ROM (P = 0.751), WOMAC (P = 0.678), or KSS (P = 0.806) in the gain scores analysis.

CONCLUSION

Metal mold-based spacers and silicone mold-based spacers demonstrate no significant differences in functional assessment (ROM, KSS, and WOMAC) or infection control. These findings indicate that silicone mold-based spacers may serve as a reliable alternative to conventional metal mold-based spacers, particularly in low-income countries.