Articular spacers in two-stage revision arthroplasty for prosthetic joint infection of the hip and the knee

Abstract

Use of articular antibiotic-eluting cement spacers during two-stage revision arthroplasty for prosthetic joint infection (PJI) is a long-established and proven adjunctive technique during first-stage surgery. Articular spacers come in many forms, either static or dynamic. The authors present an instructional review of current evidence regarding their use. A total of 45 studies (for spacer use in PJI involving either hip or knee) were analysed for data regarding eradication rate, functional outcomes, mechanical complications and the impact on second-stage surgery. A large number of case series and retrospective cohort studies were retrieved, with only a small number of prospective studies (2). High levels of infection eradication were commonly reported (>80%). Outcome scores were commonly reported as indicating good-to-excellent function and pain levels. Second-stage procedures were often not required when dynamic spacers were used. Static spacers were associated with more mechanical complications in both the hip and the knee. In the hip, dynamic spacers were more commonly associated with instability compared to static spacers. Consideration should be given to the use of dual-mobility or constrained definitive acetabular components in these cases at second-stage surgery. The use of antibiotic-eluting polymethylmethacrylate articular spacers in two-stage revision for PJI of hip and knee arthroplasty achieves a high rate of infection eradication. Dynamic spacers may confer a variety of benefits compared to static spacers, with a similar rate of infection eradication.

Analysis of the clinical efficacy of two-stage revision surgery in the treatment of periprosthetic joint infection in the knee: A retrospective study

“…Spacer, made with a ratio of 40 g bone cement to 4 g vancomycin, sustainably releases high concentrations of antibiotics locally to control infection. Individually made articular spacers can appropriately maintain the knee space and lateral collateral ligament tension, effectively prevent soft tissue contracture around the prosthesis, and maximally preserve knee function, which is convenient for the second-stage revision exposure of the surgical field and the recovery of postoperative joint function[ 25 - 27 ]. Studies have shown that 3D-printed articular spacers can provide satisfactory ROM during the spacer exclusion period, prevent bone loss, and reduce the rate of infection and complications[ 28 ].…”

Articulating spacers: what are available and how to utilize them?

“…2 ). Nevertheless, it is noteworthy that molded spacers reportedly increase the cost of the procedure, and their incidence of mechanical complications [ 13 , 35 ].

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“…The aforementioned issues can be solved by an articulating spacer, which allows for functional movement of the residual joint and provides better conditions for reimplantation [ 12 ]. It remains to be noted that articulating spacers should be avoided in cases of severe bone loss or soft tissue defect since they may not offer sufficient stability [ 13 ]. Recently, a number of studies have assessed the performance of various types of spacers in the two-stage revision, but high-quality guidelines remain scarce.…”

Characterizing recurrent infections after one-stage revision for periprosthetic joint infection of the knee: a systematic review of the literature

“…This procedure allows both local antibiotics administration in a concentration above the minimum effective concentration for approximately two weeks and adequate soft tissue tension during the interval period. First introduced in the early 1980s by John Insall, it should provide a higher eradication rate than other surgical solutions [10][11][12]. However, two-stage revision is associated with longer hospitalization, higher costs, and poor quality of life during the interval period [13].…”