Influence of the Type of Bone Cement Used in Two-Stage Exchange Arthroplasty for Chronic Periarticular Joint Infection on the Spacer Replacement and Reinfection Rate

Abstract

Background: Antibiotic-loaded bone cement (ALBC) spacers are used in the first stage when treating periprosthetic joint infection (PJI). This study aimed to investigate whether a spacer made from commercial ALBC or plain bone cement with additional antibiotics could affect the spacer exchange rate before reimplantation. Methods: Patients undergoing two-stage exchange arthroplasty due to chronic PJI from January 2014 to August 2021 were retrospectively reviewed. The exclusion criteria included arthroplasty in the setting of septic arthritis, megaprosthesis, atypical pathogen infection, spacer placement unrelated to PJI, and spacer exchange due to mechanical complications. The patient demographics, brand of cement, and microbiology were recorded manually. The primary outcome was the incidence of spacer exchange due to persistent infection and the secondary outcome was the incidence of reinfection after reimplantation. A multivariate logistic regression analysis and Chi-square test were conducted to identify the effect of cement type on the spacer exchange. Results: A total of 334 patients underwent two-stage exchange arthroplasty for PJI. The spacer exchange rates in the commercial and non-commercial ALBC groups were 6.4% and 25.1%, respectively (p = 0.004). After controlling for confounding factors, there were significant differences between the commercial group and non-commercial groups in the spacer exchange rate (adjusted OR = 0.25; 95% CI = 0.72–0.87, p = 0.029). The use of commercial ALBC was not associated with a lower reinfection rate after reimplantation (p = 0.160). Conclusions: In a two-stage exchange arthroplasty scenario, the spacer comprised of commercial ALBC resulted in a lower spacer exchange rate than the plain bone cement, both of which had additional antibiotics. However, the use of commercial ALBC was not associated with a lower incidence of reinfection following reimplantation.

Do High Doses of Multiple Antibiotics Loaded into Bone Cement Spacers Improve the Success Rate in Staphylococcal Periprosthetic Joint Infection When Rifampicin Cannot Be Employed?

“…Instead, we relied on the average standardized concentration of hand-mixed antibiotics per cement pack to represent the spacer’s antibiotic content and analyze the impact of additional antibiotics. While antibiotic elution was undoubtedly influenced by the antibiotic amount, Duey et al highlighted that antibiotic release was correlated with the specimen’s surface area rather than its volume [ 48 ]. Finally, although the cohort in this study is relatively large, some predictive variables may not reach significance because of the limited sample size.…”

Augmented Articulating Spacers in Infected Total Knee Arthroplasty: Surgical Technique

“…Two main types of articulating spacers are utilized in knee PJI treatment: the mold spacer and the metal-on-poly spacer. The mold spacer is made solely from bone cement, available in limited sizes, and preformed to resemble the appropriate femoral and tibial prosthetic components [10]. Advantages of this kind of spacer are limited costs, ease of crafting, and easier removal in the second stage.…”