Spacers in two-stage strategy for periprosthetic infection

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management
• Biomaterials Science

Background:

• Two-stage revision surgery is a common approach for infected orthopedic implants.
• Joint spacers play a critical role in delivering antibiotics and preserving joint function between surgical stages.
• Effective management of periprosthetic joint infection requires careful consideration of antibiotic properties and spacer characteristics.

Purpose of the Study:

• To review the essential characteristics of antibiotics used in cement spacers for optimal joint diffusion.
• To outline the procedural steps involved in two-stage revision surgery for infected implants.
• To categorize available joint spacer types and discuss associated complications.

Main Methods:

• Literature review focusing on antibiotic properties, two-stage revision techniques, and spacer types.
• Analysis of antibiotic requirements for cement spacers (heat resistance, solubility, stability).
• Categorization of spacers into static and dynamic types based on articulation and application.

Main Results:

• Antibiotics must be heat-resistant, water-soluble, and chemically stable in cement; gentamicin and vancomycin are preferred.
• Two-stage revision involves implant removal, spacer insertion, and reimplantation at 6 weeks to 3 months.
• Static spacers are for bone defects/soft tissue issues; dynamic spacers preserve joint function. Common complications include spacer dislocation and breakage.

Conclusions:

• Selection of appropriate antibiotics and spacer biomechanical/bacteriological properties is vital for efficacy and complication reduction.
• Systematic antibiotic therapy for at least 3 months is recommended for periprosthetic joint infection.
• Careful consideration of spacer type (static vs. dynamic) based on joint and patient factors is essential.