Comparison of the efficacy of static versus articular spacers in two-stage revision surgery for the treatment of infection following total knee arthroplasty: a meta-analysis

BACKGROUND: The aim of this study was to compare the outcomes of static versus articular spacers in two-stage reimplantation for the treatment of infected total knee arthroplasty (TKA). METHODS: The literature regarding the articulating and static spacers for treating infected TKA were searched in PubMed, Embase, Cochrane Library, Chinese Periodical Full-Text Database of CNKI, and Wanfang database. Data were extracted according to the inclusion and exclusion criteria and analyzed by Review Manager 5.3. RESULTS: Ten studies were included to this meta-analysis (nine retrospective studies, one prospective study) according to the principle of PICOS. There was no significant difference regarding the eradication rate (P = 0.28) and the American Knee Society knee score (KSS) pain score (P = 0.11) between the articulating and static spacers in the two-stage revision surgery. There was no significant difference regarding quadriceps femoroplasty and tibial tubercle osteotomy between the two groups (P = 0.50). The knee range of motion (ROM), Hospital for Special Surgery (HSS) score, and KSS function score in the articulating group were significantly higher than those in the static group (P < 0.00001). CONCLUSION: Articulating spacers can provide better ROM and knee function scores after revision surgery when compared to static spacer while not compromising the infection eradication rate, soft tissue contracture during exclusion period, and knee pain scores.