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Review
. 2024 Aug 15;13(8):772.
doi: 10.3390/antibiotics13080772.

Antimicrobial Regimens in Cement Spacers for Periprosthetic Joint Infections: A Critical Review

Symeon Naoum  1 , Christos Koutserimpas  2   3 , Ioannis Pantekidis  4 , Vasileios Giovanoulis  5 , Enejd Veizi  6 , Maria Piagkou  3 , Petros Ioannou  7 , George Samonis  7   8 , Aglaia Domouchtsidou  9 , Andreas G Tsantes  9   10 , Dimitrios V Papadopoulos  11
Affiliations
Review

Antimicrobial Regimens in Cement Spacers for Periprosthetic Joint Infections: A Critical Review

Symeon Naoum et al. Antibiotics (Basel). .

Abstract

Antibiotic-loaded cement spacers (ALCSs) are essential for treating periprosthetic joint infections (PJIs) by providing mechanical support and local antibiotic delivery. The purpose of this review is to comprehensively examine the various types of spacers utilised in the management of periprosthetic joint infections (PJIs), including both static and articulating variants and to analyse the fundamental principles underlying spacer use, their clinical benefits, the selection and administration of antimicrobial agents, appropriate dosages, and potential adverse effects. Articulating spacers, which allow joint mobility, often yield better outcomes than static ones. Spacer pharmacokinetics are vital for maintaining therapeutic antibiotic levels, influenced by cement porosity, mixing techniques, and the contact area. Antibiotic choice depends on heat stability, solubility, and impact on cement's mechanical properties. Mechanical properties are crucial, as spacers must withstand physical stresses, with antibiotics potentially affecting these properties. Complications, such as tissue damage and systemic toxicity, are discussed, along with mitigation strategies. Future advancements include surface modifications and novel carriers to enhance biofilm management and infection control.

Keywords: arthroplasty infections; cement; hip; joint reconstruction; knee; periprosthetic joint infections.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
An example of a hand-made static antibiotic-loaded cemented spacer in a case of severe periprosthetic joint infection. Anteroposterior and lateral post-operative radiographic views of the right knee after removal of the infected implants and placement of a cemented spacer loaded with vancomycin and gentamycin, fixed with two metal rods [50]. [Authors’ previously published work, used under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/, accessed on 10 August 2024).].
Figure 2
Figure 2
Complications related to antibiotic-loaded cement spacers (ALCSs).
See this image and copyright information in PMC

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