Two-Stage Revision Arthroplasty for the Treatment of Prosthetic Joint Infection

Abstract

Purpose of review: To review the diagnosis and treatment of prosthetic joint infection (PJI) with a focus on two-stage revision arthroplasty. The text will discuss different spacer constructs in total knee and total hip arthroplasty and will present clinical outcome data for these various options.

Recent findings: There is no appreciable difference in infection eradication between mobile and static antibiotic spacers. Mobile spacers have shown improved knee range of motion after second-stage re-implantation. Two-stage revision arthroplasty is the gold standard treatment for PJI. The first stage involves removal of all components, cement, and compromised soft tissues with placement of an antibiotic-impregnated spacer. Spacer options include both mobile and static spacers. Mobile spacers offer maintenance of ambulation and joint range of motion between staged procedures and have shown to be as effective in eradicating infection as static spacers.

Keywords: Antibiotic spacer; Prosthetic joint infection; Total hip arthroplasty; Total knee arthroplasty; Two-stage revision.

Fig. 1

Anteroposterior and lateral radiographs of a cement-on-cement prefabricated articulating spacer (Zimmer Biomet, Warsaw, IN) with metal dowels coated with antibiotic impregnated cement and placed into the femoral and tibial canals

Fig. 2

Anteroposterior and lateral radiographs of a metal-on-polyethylene articulating spacer. A metal femoral component is fixed onto the distal femur and a polyethylene component fixed onto the tibia, both with antibiotic impregnated cement

Fig. 3

Anteroposterior radiograph of a PROSTALAC (Depuy-Synthes, Warsaw, IN) hip antibiotic spacer. A constrained polyethylene acetabular cup is fixed to the acetabulum with antibiotic impregnated cement and a prefabricated metal femoral component coated with antibiotic cement is fixed into the femur