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

Abstract

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.