Research Article| Volume 35, ISSUE 3, SUPPLEMENT , S31-S34, March 2020

Spacer Design Options and Consideration for Periprosthetic Joint Infection


      An articulating or nonarticulating antibiotic hip spacer can be placed following the first stage implant removal of a periprosthetic hip joint infection. Antibiotic spacers help fill in the dead space created at the time of resection and provide a high local concentration of antibiotics. Theoretical advantages of a static spacer include a higher elution of antibiotics because of the increased surface area, the ability to protect deficient bone in the proximal femur/acetabulum, and the ability to immobilize the periarticular soft tissues. Advantages of an articulating spacer include improved ambulation and easier motion for the patient, maintenance of soft tissue tension, and an easier surgical reconstruction at the time of the second stage. Additionally, an articulating antibiotic spacer may minimize the risk of dislocation following the second stage reconstruction. The choice of articulating or nonarticulating is currently one of surgeon preference yet it is advised that surgeons consider an articulating spacer for all patients except those with severe femoral/acetabular bone loss or deficient abductors.


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        • Anagnostakos K.
        • Furst O.
        • Kelm J.
        Antibiotic-impregnated PMMA hip spacers: current status.
        Acta Orthop. 2006; 77: 628-637
        • Masri B.A.
        • Duncan C.P.
        • Beauchamp C.P.
        Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system.
        J Arthroplasty. 1998; 13: 331-338
        • Fehring T.K.
        • Odum S.
        • Struble S.
        • Fehring K.
        • Griffin W.L.
        • Mason J.B.
        Hip instability in 2-stage reimplantation without an articulating spacer.
        J Arthroplasty. 2007; 22: 156-161
        • Lausmann C.
        • Citak M.
        • Hessling U.
        • Wolff M.
        • Gehrke T.
        • Suero E.M.
        Preliminary results of a novel spacer technique in the management of septic revision hip arthroplasty.
        Arch Orthop Trauma Surg. 2018; 138: 1617-1622
        • Biring G.S.
        • Kostamo T.
        • Garbuz D.S.
        • Masri B.A.
        • Duncan C.P.
        Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study.
        J Bone Joint Surg Br. 2009; 91: 1431-1437
        • Degen R.M.
        • Davey J.R.
        • Davey J.R.
        • Howard J.L.
        • McCalden R.W.
        • Naudie D.D.
        Does a prefabricated gentamicin-impregnated, load-bearing spacer control periprosthetic hip infection?.
        Clin Orthop Relat Res. 2012; 470: 2724-2729
        • Masri B.A.
        • Duncan C.P.
        • Beauchamp C.P.
        • Paris N.J.
        • Arntorp J.
        Effect of varying surface patterns on antibiotic elution from antibiotic-loaded bone cement.
        J Arthroplasty. 1995; 10: 453-459
        • Tikhilov R.
        • Bozhkova S.
        • Denisov A.
        • Labutin D.
        • Shubnyakov I.
        • Razorenov V.
        • et al.
        Risk factors and a prognostic model of hip periprosthetic infection recurrence after surgical treatment using articulating and non-articulating spacers.
        Int Orthop. 2016; 40: 1381-1387
        • Veltman E.S.
        • Moojen D.J.
        • Glehr M.
        • Poolman R.W.
        Similar rate of infection eradication for functional articulating, prefabricated and custom-made spacers in 2-stage revision of the infected total hip: a literature review.
        Hip Int. 2016; 26: 319-326
        • Belden K.
        • Cao L.
        • Chen J.
        • Deng T.
        • Fu J.
        • Guan H.
        Hip and knee section, fungal periprosthetic joint infection, diagnosis and treatment: proceedings of international consensus on orthopedic infections.
        J Arthroplasty. 2019; 34: S387-S391