Modern Description of Antibiotic Spacer Options for PJI in Revision Total Knee Arthroplasty: Clinical Outcomes and Infection Eradication Rates

Abstract

Background: As the burden of periprosthetic joint infections (PJIs) increases, there is growing interest in understanding the efficacy and morbidity reduction of 2-stage revision and various antibiotic spacer options. This study aimed to expand the description and evaluation of spacers from solely their articulation status to include their ability to support full (functional) or partial weight-bearing (nonfunctional).

Methods: Between 2002 and 2021, 391 patients who had Musculoskeletal Infection Society criteria for PJI with 1-stage or 2-stage revision were included. Demographics, functional outcomes, and subsequent revision data were collected. The study population had a mean follow-up of 2.9 years (range, 0.05-13.0) with an average age of 67 years (range, 34.7-93.4). Spacer failure was defined by surgical intervention following definitive surgery, and infection eradication was defined by the Delphi criteria. Spacers were classified as nonfunctional static, nonfunctional dynamic, functional static, or functional dynamic. Two tailed t-tests were performed.

Results: There were no significant differences in infection eradication or mechanical outcomes across spacer types; notably, 97.3% of functional dynamic spacers achieved infection eradication. Functional spacers had a longer time to the second stage procedure and a greater number of patients who had not been reimplanted. There was no difference in reoperation rates in nonfunctional versus functional spacers.

Conclusion: Within this cohort, infection eradication and spacer exchange rates were noninferior among spacers. Functional spacers may allow for earlier return to daily living given the weight-bearing capability when compared to nonfunctional, without sacrificing clinical outcome.

Keywords: antibiotic spacer; arthroplasty; knee; periprosthetic infection; two-stage revision.