Medical Journal of the Islamic Republic Of Iran

en Clinical Evaluation of Two-Stage Revision Total Knee Arthroplasty Using Silicone Mold-Based and Metal Mold-Based Antibiotic-Loaded Knee Spacers: A Comparative Study Orthopedic Orthopedic Original Research: Clinical Science Original Research: Clinical Science     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.   Total Knee Arthroplasty, Two-Stage Revision, Knee Spacer, Metal Mold, Silicon Mold 463 469 http://mjiri.iums.ac.ir/browse.php?a_code=A-10-9335-1&slc_lang=en&sid=1 Mohamad Amin Younessi Heravi a.younessi7@gmail.com 200319475328460097870 200319475328460097870 No Department of Medical Physics and Radiology, School of Allied Medical Sciences, North Khorasan University of Medical Sciences, Bojnurd, Iran Reza Ganji armin.ganji@gmail.com 200319475328460097871 200319475328460097871 No Department of Orthopedic Surgery, School of Medicine, Imam Ali Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran Ismaeil Garivani Milad.gerivani@gmail.com 200319475328460097872 0009-0001-1854-1281 No Department of Orthopedic Surgery, School of Medicine, Imam Ali Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran Negin Armide n.armide@nkums.ac.ir 200319475328460097873 0009-0006-6787-8733 Yes Clinical Research Development Unit of Imam Hasan Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran