Non-Articulating Spacers Increase the Risk of Patella Baja in the Treatment of Chronic Periprosthetic Joint Infections of the Knee.

BACKGROUND Patellar baja is a known complication following primary and revision total knee arthroplasty. Static, or non-articulating, spacers for total knee arthroplasty periprosthetic joint infection can result in shortening of the extensor mechanism, though no comparison to articulating spacers has been performed. This study aimed to evaluate the association between spacer type and the incidence of true patellar baja.

METHODS We retrospectively reviewed 179 patients who underwent two-stage revision arthroplasty for chronic knee periprosthetic joint infection (97 non-articulating and 82 articulating spacers). The primary outcome was the development of patellar baja measured via modified Insall-Salvati and Blackburn-Peel ratios. A binary logistic regression model was used to assess the association between spacer type and patellar baja, adjusting for potential confounders including age, sex, American Society of Anesthesiologists score, presence of augments, cones/sleeves, and preoperative arc of motion. Cumulative incidence functions were used to compare the risk of revision surgery (for infection and for any cause) between spacer types, treating death as a competing risk.

RESULTS Patellar baja occurred in 13 (7%) patients. Patients receiving non-articulating spacers were significantly more likely to develop true patellar baja compared to those receiving an articulating spacer (11 of 97 versus two of 82, respectively, P = 0.02). In the multivariable analysis, non-articulating spacers remained significantly associated with higher odds of true patellar baja (odds ratio = 8.9, P = 0.04). There were no significant differences in the cumulative incidence of revision for infection (P = 0.98) or any cause (P = 0.25). Patients who developed patellar baja also had significantly reduced knee flexion at final follow-up compared to those who did not (mean 82 versus 105°, P = 0.01).

CONCLUSIONS Non-articulating spacers used during two-stage revision arthroplasty were associated with an increased risk of patellar baja compared with articulating spacers, and the development of patellar baja was associated with worse postoperative knee flexion. When clinically feasible, articulating spacers may help preserve extensor mechanism function and optimize postoperative knee motion.