Comparison of Traditional Molded, First-Generation Premolded, and Second-Generation Premolded Antibiotic-Loaded Polymethylmethacrylate Articulating Spacers for Treatment of Chronic Prosthetic Joint Infection of the Knee

  • David K. DeBoer
    Reprint requests: David K. DeBoer, MD, Southern Joint Replacement Institute, 2400 Patterson St., Suite 100, Nashville, TN 37203.
    Southern Joint Replacement Institute, Nashville, TN
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      The purpose of this study was to compare patients who had chronic prosthetic joint infection treated using three methods of articulating polymethylmethacrylate spacers in two-stage reimplantation.


      We identified 77 patients who had chronic prosthetic joint infection with a minimum of one-year follow-up. Reinfection rates were determined using modified International Consensus group criteria.


      The overall reinfection rate was 18% (14 of 77 patients). Despite a higher medical comorbidity in the second-generation spacer cohort, there were no statistical differences in reinfection rates between articulating spacer types.


      This study suggests that there were no differences in efficacy between the traditional molded, first-generation premolded, and second-generation premolded articulating spacers, but more studies with high level of evidence are needed.


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        • Peersman G.
        • Laskin R.
        • Davis J.
        • Peterson M.
        Infection in total knee replacement: a retrospective review of 6489 total knee replacements.
        Clin Orthop Relat Res. 2001; : 15-23
        • Lavernia C.
        • Lee D.J.
        • Hernandez V.H.
        The increasing burden of knee revision surgery in the United States.
        Clin Orthop Relat Res. 2006; 446: 221-226
        • Lombardi A.
        • Karnes J.
        • Berend K.
        A motion maintaining antibiotic delivery system.
        J Arthroplasty. 2007; 22: 50-55
        • Pivec R.
        • Naziri Q.
        • Issa K.
        • Banerjee S.
        • Mont M.
        Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty.
        J Arthroplasty. 2014; 29: 553-557
        • Guild G.
        • Wu B.
        • Scuderi G.
        Articulating vs. Static antibiotic impregnated spacers in revision total knee arthroplasty for sepsis. A systematic review.
        J Arthroplasty. 2014; 29: 558-563
        • Parvizi J.
        • Gehrke T.
        Definition of periprosthetic joint infection.
        J Arthroplasty. 2014; 29: 1331
        • McPherson E.J.
        • Woodson C.
        • Holtom P.
        • Roidis N.
        • Shufelt C.
        • Patzakis M.
        Peri- prosthetic total hip infection: outcomes using a staging system.
        Clin Orthop Relat Res. 2002; : 8-15
        • Fehring T.K.
        • Odum S.
        • Calton T.F.
        • Mason J.B.
        Articulating versus static spacers in revision total knee arthroplasty for sepsis. The Ranawat Award.
        Clin Orthop Relat Res. 2000; : 9-16
        • Goltz D.
        • Sutter E.
        • Bolognesi M.
        • Wellman S.
        Outcomes of articulating spacers with autoclaved femoral components in total knee arthroplasty infection.
        J Arthroplasty. 2018; 33: 2595-2604