The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty

Health-related quality of life with long-term retention of the PROSthesis of Antibiotic Loaded Acrylic Cement system following infection resolution in low demand patients

“…Others have noted similar results up to 4 years in small numbers of patients. [12][13][14] Similar to our study, those subjects tended to be lower demand subjects who were poor surgical risks. Further research is required as it would be important to better characterize what subjects may be appropriate for consideration of this management approach.…”

“…9,10 Although designed as a temporary spacer, 8,11 a few studies with a limited number of patients have reported successful retention of cement spacers on a longer term basis. [12][13][14] We previously evaluated infection resolution and healthrelated quality of life (HRQL) with the PROSTALAC in situ using a retrospective, cross-sectional design. 10 The primary objective of this prospective longitudinal study was to report HRQL with the PROSTALAC in situ and then following second stage surgery for patients with infected THA.…”

The Fate of Spacers in the Treatment of Periprosthetic Joint Infection

“…Despite having a lower reimplantation rate, the first stage as a starting point better represents the actual clinical course and explains the seemingly low infection eradication rates reported in the current study and previous reports from our institution [35][36][37][38] . It is also important to point out that, even for patients in the present study who ultimately underwent reimplantation, many underwent spacer exchange or surgical intervention for wound-related problems in the interstage period, with all of the inherent risks of added surgical procedures 19,39,40 . In nearly one of five patients, the intended two-stage exchange never occurred, with patients requiring arthrodesis or amputation or resorting to living with the implanted spacers.…”

“…T he success of two-stage exchange arthroplasty for the treatment of chronic periprosthetic joint infection has been reported to approach or to exceed 80% in the majority of studies [16][17][18][19][20][21][22] . However, there is a widespread heterogeneity on the reporting of the clinical outcomes of two-stage exchange arthroplasty.…”

“…Within the literature, there is considerable variation in the reimplantation rates following explantation, ranging from 28.6% 24 to 100% [25][26][27][28][29] , and most studies have demonstrated reimplantation rates above 80% 1,2,5,[30][31][32][33][34] . Failure to reimplant may occur for a variety of reasons, including mortality, medical comorbidity, patients lost to follow-up, patients satisfied with their current level of function in the setting of a retained spacer 19 , and persistent infection that may ultimately result in definitive treatment with amputation, arthrodesis, or lifetime antibiotic suppression. Therefore, the reimplantation rates within the literature and in the present study suggest that the number of patients who fail to undergo reimplantation is not inconsequential and that reported outcomes following completion of the second stage neglect the nearly 20% of treatment failures in the interstage period.…”