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Real Component Spacers for Two-Stage Exchange Demonstrate Low Bacterial Colonization.

Logan E Finger1, Alan E Wilson1, Brandon K Couch1

  • 1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.

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Real component (RC) spacers in two-stage exchange arthroplasty for periprosthetic joint infection (PJI) showed fewer positive sonication fluid cultures. However, RC spacers did not significantly differ in infection recurrence or revision rates compared to other spacer types.

Keywords:
Bacterial colonizationPeriprosthetic joint infectionReal-component spacersSonicationTwo-stage exchange

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Area of Science:

  • Orthopedic Surgery
  • Infectious Disease
  • Biomaterials Science

Background:

  • Chronic periprosthetic joint infection (PJI) management often involves two-stage exchange arthroplasty.
  • Real component (RC) spacers offer functional benefits but raise concerns about bacterial colonization.
  • Evaluating bacterial colonization and clinical outcomes associated with different spacer types is crucial.

Purpose of the Study:

  • To compare the efficacy of real component (RC) spacers versus articulating cement (AC) and static spacers (SS) in reducing bacterial load.
  • To assess the impact of spacer type on clinical outcomes, including reinfection and revision rates in PJI treatment.

Main Methods:

  • Retrospective review of 112 patients undergoing two-stage exchange arthroplasty for hip or knee PJI.
  • Explanted spacer components were analyzed using sonication fluid culture (SFC).
  • Clinical data including reoperations and revisions were collected and compared across spacer groups.

Main Results:

  • Real component (RC) spacers demonstrated significantly lower rates of positive sonication fluid cultures (SFCs) compared to articulating cement (AC) and static spacers (SS) (P = .01).
  • No significant differences were observed in positive tissue cultures, 90-day repeat debridement rates, all-cause revisions, or infection-related revisions among the three spacer groups.
  • Specifically, 0% of RC patients required repeat debridement within 90 days, versus 11.8% for AC and 4.5% for SS.

Conclusions:

  • Real component (RC) spacers may reduce bacterial burden detectable by sonication fluid culture in PJI treatment.
  • Despite lower SFC positivity, RC spacers did not show a significant advantage in preventing recurrent infections or revisions compared to AC and SS spacers.
  • Further research is warranted to fully elucidate the long-term clinical impact and biofilm potential of RC spacers in PJI management.