Antibiotic Spacers for Prosthetic Joint Infections Following Total Knee Arthroplasty

For many years two-stage revision arthroplasty has been considered the standard treatment for chronic deep prosthetic joint infection following total knee arthroplasty. The initial stage involves placement of an antibiotic joint spacer to deliver high-dose local antibiotic concentrations, followed by a variable duration (usually 6–8 weeks) of systemic antibiotic therapy. The second stage is performed after presumed eradication of infection. Various types of antibiotic cement spacers have been used, including static, articulating, and functional. Sustained elution of antibiotics into the joint fluid and periarticular tissues provides local high concentrations of antimicrobials that may be necessary for eradication of biofilms and prevent development of resistant organisms. Although articulating spacers may provide a small improvement in the final range-of-motion following reimplantation, there is no conclusive data supporting the use of one type of spacer for eradication of infection.