A motion maintaining antibiotic delivery system

Abstract

Two-stage radical debridement with implant removal, antibiotic therapy, and delayed reimplantation remains the treatment of choice for deep infection in total joint arthroplasty. Studies have shown that articulating vs static spacers better improve functional results, increase patient satisfaction, prevent bone loss, and facilitate reimplantation without increasing risk of infection. Articulating spacers fabricated from cement provide a vehicle for prolonged local delivery of antibiotics. We currently use a mold system for creating antibiotic-laden articulating cement spacers. Disposable femoral and tibial molds are injection-filled with low-viscosity cement vacuum mixed with 3.6 to 4.8 g of tobramycin or gentamicin and 3.0 to 4.0 g of vancomycin per 40-g unit and massaged to fill any voids. After curing, the temporary spacers are removed from the molds, trimmed smooth, and cemented loosely into the joint space.