Long-Term Outcomes of Permanent Cement Spacers in the Infected Foot

When osteomyelitis occurs in the infected foot, cement spacers have been used as a limb salvage tool. The aim of the present study was to assess the longevity and outcomes in high-risk, low-demand patients who have undergone resection of bone and subsequent placement of permanent antibiotic-eluting cement spacers in the foot. A retrospective review case series of 30 patients who had undergone placement of a permanent antibiotic-eluting cement spacer in the foot were evaluated for retention, spacer exchange, removal, amputation, and functional status. The minimum follow-up time for inclusion was 12 months. Two thirds of all patients had successful spacers (n = 20) that were either retained (n = 14) or successfully exchanged (n = 6). One third of all patients experienced spacer failure (n = 10) and required removal. Of the 10 patients requiring spacer removal, 4 underwent removal with subsequent arthrodesis and 6 underwent removal with subsequent pseudoarthrosis. Also, 8 of these patients (26.7%) required partial foot amputation of the ipsilateral foot. These amputations were not directly related to the use or removal of the spacer. The average time to spacer removal or partial amputation was 20.9 (range 0.2 to 60.9) months. The longest retained spacer in the foot was 76 months at the last follow-up visit. The longest exchanged spacer at the last follow-up visit was 111 months. All surviving patients were ambulatory at the last follow-up visit.