{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:36Z","timestamp":1760144736337,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"China Medical University Hospital","award":["DMR-113-199"],"award-info":[{"award-number":["DMR-113-199"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Two-stage revision with an antibiotic-loaded cement articulating spacer is a standard treatment for chronic prosthetic knee infection (PKI); however, mechanical complications can occur during the spacer period. There is limited evidence on the association between surgeon volume and mechanical complications after resection arthroplasty (RA) using an articulating spacer. This study aimed to compare the rates of mechanical complications and reoperation after RA with articulating spacers by surgeons with high volumes (HV) and low volumes (LV) of RA performed and analyzed the risk factors for mechanical failure. The retrospective study investigated 203 patients treated with PKIs who underwent RA with articulating spacers and were divided according to the number of RAs performed by the surgeons: HV (\u226514 RAs\/year) or LV (&lt;14 RAs\/year). Rates of mechanical complications and reoperations were compared. Risk factors for mechanical complications were analyzed. Of the 203 patients, 105 and 98 were treated by two HV and six LV surgeons, respectively. The mechanical complication rate was lower in HV surgeons (3.8%) than in LV surgeons (36.7%) (p &lt; 0.001). The reoperation rate for mechanical complications was lower in HV surgeons (0.9%) than in LV surgeons (24.5%) (p &lt; 0.001). Additionally, 47.2% of patients required hinge knees after mechanical spacer failure. Medial proximal tibial angle &lt; 87\u00b0, recurvatum angle &gt; 5\u00b0, and the use of a tibial spacer without a cement stem extension were risk factors for mechanical complications. Based on these findings, we made the following three conclusions: (1) HV surgeons had a lower rate of mechanical complications and reoperation than LV surgeons; (2) mechanical complications increased the level of constraint in final revision knee arthroplasty; and (3) all surgeons should avoid tibial spacer varus malalignment and recurvatum deformity and always use a cement stem extension with a tibial spacer.<\/jats:p>","DOI":"10.3390\/jpm14050490","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T05:52:02Z","timestamp":1714715522000},"page":"490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Surgeon Volume on Mechanical Complications after Resection Arthroplasty with Articulating Spacer"],"prefix":"10.3390","volume":"14","author":[{"given":"Chih-Yuan","family":"Ko","sequence":"first","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Hao","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 40604, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Chin","family":"Fong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 40604, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2390-9626","authenticated-orcid":false,"given":"Hui-Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Radiology, China Medical University Hospital, Taichung 40447, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsien-Te","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 40604, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9480-8224","authenticated-orcid":false,"given":"Tsung-Li","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan"},{"name":"Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan"},{"name":"Department of Sports Medicine, College of Health Care, China Medical University, Taichung 40604, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S53","DOI":"10.1016\/j.arth.2019.11.008","article-title":"Comparison of Traditional Molded, First-Generation Premolded, and Second-Generation Premolded Antibiotic-Loaded Polymethylmethacrylate Articulating Spacers for Treatment of Chronic Prosthetic Joint Infection of the Knee","volume":"35","author":"DeBoer","year":"2020","journal-title":"J. Arthroplast."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.arth.2023.07.015","article-title":"History of Diabetic Foot Ulcer is Associated With Increased Risk of Prosthetic Joint Infection and Sepsis After Total Joint Arthroplasty","volume":"39","author":"Magruder","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1016\/j.arth.2022.12.033","article-title":"Does Prednisone Dose Affect Rates of Periprosthetic Joint Infection Following Primary Total Hip and Total Knee Arthroplasty?","volume":"38","author":"Piple","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1016\/j.arth.2023.08.012","article-title":"Inferior Outcomes for Patients Transferred Between Surgical Stages for Knee Periprosthetic Joint Infection","volume":"39","author":"Florance","year":"2024","journal-title":"J. Arthroplast."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"778","DOI":"10.2106\/JBJS.19.00915","article-title":"A Randomized Trial of Static and Articulating Spacers for the Treatment of Infection Following Total Knee Arthroplasty","volume":"102","author":"Nahhas","year":"2020","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_6","first-page":"422","article-title":"Spacer-related problems in two-stage revision knee arthroplasty","volume":"79","author":"Struelens","year":"2013","journal-title":"Acta Orthop. Belg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.arth.2015.07.009","article-title":"The Effect of Subluxation of Articulating Antibiotic Spacers on Bone Defects and Degree of Constraint in Revision Knee Arthroplasty","volume":"31","author":"Lau","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.arth.2022.01.094","article-title":"Posterior-Stabilized Antibiotic Cement Articulating Spacer with Endoskeleton-Reinforced Cam Reduces Rate of Post-Cam Mechanical Complications in Prosthetic Knee Infection: A Preliminary Study","volume":"37","author":"Lin","year":"2022","journal-title":"J. Arthroplast."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.2106\/JBJS.15.01365","article-title":"Meaningful Thresholds for the Volume-Outcome Relationship in Total Knee Arthroplasty","volume":"98","author":"Wilson","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1302\/0301-620X.103B6.BJJ-2020-2287.R1","article-title":"High-volume revision surgeons have better outcomes following revision total knee arthroplasty","volume":"103","author":"Roof","year":"2021","journal-title":"Bone Jt. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S314","DOI":"10.1016\/j.arth.2023.03.082","article-title":"Does Treatment at a Specialized Prosthetic Joint Infection Center Improve the Rate of Reimplantation?","volume":"38","author":"Fehring","year":"2023","journal-title":"J. Arthroplast."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3750","DOI":"10.1016\/j.arth.2021.06.023","article-title":"Cruciate-Retaining vs Posterior-Stabilized Antibiotic Cement Articulating Spacers for Two-Stage Revision of Prosthetic Knee Infection: A Retrospective Cohort Study","volume":"36","author":"Lin","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1016\/j.arth.2014.03.009","article-title":"Definition of periprosthetic joint infection","volume":"29","author":"Parvizi","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1245\/s10434-011-2090-8","article-title":"Influence of surgical volume on outcome for laparoscopic hysterectomy for endometrial cancer","volume":"19","author":"Wright","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2106\/JBJS.16.00290","article-title":"Vancomycin and Ceftazidime in Bone Cement as a Potentially Effective Treatment for Knee Periprosthetic Joint Infection","volume":"99","author":"Hsu","year":"2017","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1007\/s11999-013-2866-1","article-title":"Success after treatment of periprosthetic joint infection: A Delphi-based international multidisciplinary consensus","volume":"471","author":"Higuera","year":"2013","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1186\/s13018-019-1175-0","article-title":"A preliminary study of the novel antibiotic-loaded cement computer-aided design-articulating spacer for the treatment of periprosthetic knee infection","volume":"14","author":"Tsai","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.2106\/JBJS.J.00772","article-title":"The effect of alignment and BMI on failure of total knee replacement","volume":"93","author":"Ritter","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1302\/0301-620X.97B1.34440","article-title":"A comparison of patient-specific and conventional instrumentation for total knee arthroplasty: A multicentre randomised controlled trial","volume":"97","author":"Abane","year":"2015","journal-title":"Bone Jt. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00264-013-2097-9","article-title":"The relationship between the survival of total knee arthroplasty and postoperative coronal, sagittal and rotational alignment of knee prosthesis","volume":"38","author":"Kim","year":"2014","journal-title":"Int. Orthop."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"770","DOI":"10.4055\/cios22207","article-title":"Predictors of Recurrent Flexion Contracture after Total Knee Arthroplasty in Osteoarthritic Knees with Greater Than 15\u00b0 Flexion Contracture","volume":"15","author":"Song","year":"2023","journal-title":"Clin. Orthop. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Shagawa, M., Maruyama, S., Sekine, C., Yokota, H., Hirabayashi, R., Hirata, A., Yokoyama, M., and Edama, M. (2021). Comparison of anterior knee laxity, stiffness, genu recurvatum, and general joint laxity in the late follicular phase and the ovulatory phase of the menstrual cycle. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04767-8"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1016\/j.arth.2019.02.034","article-title":"Does Femoral Notching During Total Knee Arthroplasty Influence Periprosthetic Fracture. A Prospective Study","volume":"34","author":"Puranik","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/j.arth.2017.12.027","article-title":"Medial Overhang of the Tibial Component Is Associated With Higher Risk of Inferior Knee Injury and Osteoarthritis Outcome Score Pain After Knee Replacement","volume":"33","author":"Nielsen","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3038","DOI":"10.1016\/j.arth.2018.05.014","article-title":"Is Regular Knee Radiograph Reliable Enough to Assess the Knee Prosthesis Position?","volume":"33","author":"Tammachote","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1016\/j.arth.2016.03.034","article-title":"A New Classification for the Varus Knee","volume":"31","author":"Thienpont","year":"2016","journal-title":"J. Arthroplast."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1055\/s-0039-1700843","article-title":"Agreement and Reliability of Lateral Patellar Tilt and Displacement following Total Knee Arthroplasty with Patellar Resurfacing","volume":"34","author":"Kleimeyer","year":"2021","journal-title":"J. Knee Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S228","DOI":"10.1016\/j.arth.2018.03.038","article-title":"Success of Two-Stage Reimplantation in Patients Requiring an Interim Spacer Exchange","volume":"33","author":"George","year":"2018","journal-title":"J. Arthroplast."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2085","DOI":"10.1016\/j.arth.2019.04.016","article-title":"Surgical Treatment of Chronic Periprosthetic Joint Infection: Fate of Spacer Exchanges","volume":"34","author":"Tan","year":"2019","journal-title":"J. Arthroplast."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.otsr.2018.09.016","article-title":"The CRIOAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection","volume":"105","author":"Ferry","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1016\/j.knee.2019.05.010","article-title":"Improving the accuracy of tibial component placement during total knee replacement in varus knees with tibial bowing: A prospective randomised controlled study","volume":"26","author":"Palanisami","year":"2019","journal-title":"Knee"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.artd.2020.08.006","article-title":"Balanced, Stemmed, and Augmented Articulating Total Knee Spacer Technique","volume":"6","author":"Gililland","year":"2020","journal-title":"Arthroplast. Today"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3154","DOI":"10.1016\/j.arth.2021.04.020","article-title":"Posterior-Stabilized TKA in Patients with Severe Genu Recurvatum Achieves Good Clinical and Radiological Results at 5-year Minimum Follow-Up: A Case-Controlled Study","volume":"36","author":"Mesnard","year":"2021","journal-title":"J. Arthroplast."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1186\/s13018-021-02878-5","article-title":"Management of instability after primary total knee arthroplasty: An evidence-based review","volume":"16","author":"Brivio","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1016\/j.ocl.2015.09.007","article-title":"Instability After Total Knee Arthroplasty","volume":"47","author":"Cottino","year":"2016","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1402","DOI":"10.1055\/s-0041-1735281","article-title":"Zonal Fixation in Revision TKA: The Key Is Metaphyseal Fixation","volume":"34","author":"Oh","year":"2021","journal-title":"J. Knee Surg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Lee, S.H., Shih, H.N., Chang, C.H., Lu, T.W., Chang, Y.H., and Lin, Y.C. (2020). Influence of extension stem length and diameter on clinical and radiographic outcomes of revision total knee arthroplasty. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-019-3030-1"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1007\/s00264-022-05438-6","article-title":"Does spiked tibial cement spacer reduce spacer-related problems in two-stage revision total knee arthroplasty for infection?","volume":"46","author":"Jung","year":"2022","journal-title":"Int. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.jand.2013.09.018","article-title":"Practical guide to measuring physical activity","volume":"114","author":"Sylvia","year":"2014","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.knee.2019.07.001","article-title":"Intra- and interobserver reliability and agreement in three-dimensional computed tomography measurements of component positions after total knee arthroplasty","volume":"26","author":"Yoshino","year":"2019","journal-title":"Knee"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/5\/490\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:39:13Z","timestamp":1760107153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/5\/490"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,3]]},"references-count":40,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["jpm14050490"],"URL":"https:\/\/doi.org\/10.3390\/jpm14050490","relation":{},"ISSN":["2075-4426"],"issn-type":[{"type":"electronic","value":"2075-4426"}],"subject":[],"published":{"date-parts":[[2024,5,3]]}}}