87% Infection Eradication: A Data-Driven Look at a Novel Prefabricated Spacer

A surgeon's guide to maximizing interstage function and simplifying reimplantation surgery by choosing the right articulating antibiotic spacer.

First described by Insall et al, the “gold standard” for treating chronic periprosthetic joint infection (PJI) is the 2-stage revision, which involves implantation of a temporary antibiotic-loaded cement spacer until infection eradication, at which point a new prosthesis is implanted. Historically, static spacers were utilized during the interstage period for local antibiotic delivery while maintaining tension on the surrounding soft tissues. More recently, various articulating spacers have been utilized, including metal-on-polyethylene, cement-on-polyethylene, and cement-on-cement spacers.

Some cement-on-cement articulating spacers are fabricated intraoperatively, and others are commercially prefabricated. Benefits of prefabricated, cement-on-cement spacers include longer antibiotic elution, the ability to mechanically load the component, which further enhances antibiotic elution, and their availability in a variety of sizes, allowing for a closer approximation of native joint anatomy, which may restore joint biomechanics and improve interstage function.