Antibiotic-loaded bone cement spacers in two-stage management of infected total knee arthroplasty

Abstract

We reviewed the current use of spacers in the management of the infected knee prosthesis. There are two types of temporary spacers: block or non-articulating spacers and articulating or mobile spacers. Generally, spacers improve mobilisation and hasten recovery with shorter hospital stay between stages. Furthermore, spacers facilitate the second-stage procedure by maintaining joint space, and articulating spacers may also maintain range of motion. Last but not the least, the cost of spacers represents only a small fraction of the total expenses for management of infected knee arthroplasties.

Fig. 1 A

Post-operative antero-posterior and B lateral radiographs of a 75-year-old woman with total knee arthroplasty (TKA) late infection show a cemented antibiotic-loaded articulating spacer in satisfactory position

Fig. 2

The articulating spacer allows range-of-motion exercises between stages. The patient is mobilised with crutches and partial weight bearing

Fig. 3

Spacer in situ before removal and reimplantation of a new total knee arthroplasty. Slight signs of articulating surface wear are present after 8 weeks of function with partial weight-bearing and daily range-of-motion exercises