Are Static Spacers Superior to Articulated Spacers in the Staged Treatment of Infected Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis

Abstract

In the treatment of knee periprosthetic joint infection with a two-stage protocol, static spacers allow for the local delivery of high doses of antibiotics and help to preserve soft tissue tension. Articulated spacers were introduced to better preserve flexion after the reimplantation. The aim of this systematic review is to provide a comprehensive data collection of the results of these different spacers. An in-depth search on the main clinical databases was performed concerning the studies reporting data on the topic. A total of 87 studies and 4250 spacers were included. No significant differences were found both in pooling data analysis and meta-analysis of comparative studies about infection recurrences, complications, and clinical scores. Mean active knee flexion at last follow-up after total knee reimplantation was found to be significantly higher using articulated spacers (91.6° ± 7° for static spacers vs. 100.3° ± 9.9° for articulated spacers; p < 0.001). Meta-analysis also recognized this strong significant difference (p < 0.001). This review has confirmed that articulated spacers do not appear to be inferior to static spacers regarding all clinical outcomes, while they are superior in terms of active flexion. However, the low quality of the studies and the risk for selection bias with complex patients preferentially treated with static spacers need to be accounted for.

The Creation of Articulating Cement Spacer Using Custom-Fabricated Silicone Mold for the Treatment of Periprosthetic Joint Infection: Two Case Reports

“…One of the dreaded complications of arthroplasty surgery is periprosthetic joint infection (PJI) [6][7][8]. The incidence of PJI in the first two years after primary joint replacement ranges from 0.5% to 3%, and revision surgeries show a higher rate of infection, ranging from 2.5% to 4% [1][2][3][4][5][6][7][8][9][10].…”

“…PJI is associated with high rates of mortality and morbidity, adversely affecting the level of mobility and ambulation of patients, thereby reducing the quality of life [1][2][3][4][5][6][7][8][9][10]. Numerous risk factors of PJI have been identified, including advanced age, malnutrition, inflammatory diseases, obesity, diabetes mellitus, and remote infection [1][2].…”

“…Furthermore, good results of single-stage revision require a much more aggressive and complete periarticular tissue resection than two-stage, which many surgeons are not accustomed to performing [11]. As there are numerous variables that may adversely affect the outcome of single-stage revision surgeries, two-stage revision is currently considered the gold standard in the management of PJI [1][2][3][4][5][6][7][8][9][10].…”

“…A temporary cement spacer is imperative in two-stage revision surgery for PJI [9,10]. The temporary cement spacer is inserted after the debridement and removal of the infected primary prosthesis component.…”

“…The temporary cement spacer is inserted after the debridement and removal of the infected primary prosthesis component. On top of its ability to slowly elucidate topical antibiotic, temporary cement spacer also eliminates the dead space left behind by the removal of prosthesis, helping in the eradication of infection and maintaining soft-tissue tension [9,10]. Studies show that static spacers and articulating spacers are comparable in the eradication of infection, but articulating spacers are more superior in providing an improved range of movement of affected joints [9,10].…”