The use of spacers (static and mobile) in infection knee arthroplasty

Abstract

Revision total knee arthroplasty (TKA) is the treatment of choice in patients with periprosthetic joint infection. It may be performed in either a single stage or two stages. In the latter option, between stages, an antibiotic-loaded spacer may be used to maintain a certain amount of joint stability and mobility after the infected implant is removed, adding an intra-articular concentration of antibiotics. There are two types of antibiotic-loaded cement spacers: static and dynamic. Static spacers basically create a temporary arthrodesis with antibiotic-loaded cement and usually are handmade within the surgical field. Dynamic spacers can be created intraoperatively by using different tools or may be prepackaged by the manufacturer; they allow range of motion between stages. In this article, the authors review the indications, surgical techniques, and results for static and dynamic spacers in two-stage revision TKA.

Infection after total knee arthroplasty and its gold standard surgical treatment: Spacers used in two-stage revision arthroplasty

“…A review by Mazzucchelli et al reported that articulating spacers may not be used in cases where patients are found to have inadequate soft tissue cover over the knee since it may lead to problems with wound healing (28). Numerous studies have also reported that spacer fractures are a common postoperative complication of using articulating spacers (31)(32).…”

“…Articulating spacers have been found to result in a greater postoperative ROM with the same rate of infection control (28). These are several factors for this better outcome, though the main one is the preservation of the length and elasticity of extensor mechanisms.…”

“…These are several factors for this better outcome, though the main one is the preservation of the length and elasticity of extensor mechanisms. Ambulation in between revision surgeries also prevents tissue scarring around the knee, quadriceps shortening, and capsular thickening and contracture (28,33). This subsequently facilitates future revision surgeries by reducing surgical exposure and the overall difficulty of revision (34)(35).…”

“…This proves to be its main disadvantage but a static spacer is particularly suitable in situations where patients present with a severe infection with obvious swelling of the soft tissues (27)(28). The local delivery of antibiotics provides a stable localized concentration of the antibiotics used in the bone cement.…”

“…A study has reported that the main advantages of static spacers are that they provide better relief for patients with infected and congested tissues and that they cost significantly less than articulating spacers (28). However, other studies have reported that static spacers yield poor postoperative limb mobility compared to articulating spacers (6,(27)(28).…”