Archives of Orthopaedic and Trauma Surgery

, Volume 139, Issue 5, pp 695–707 | Cite as

Comparison of infection eradication rate of using articulating spacers containing bio-inert materials versus all-cement articulating spacers in revision of infected TKA: a systematic review and meta-analysis

  • Qiang Yu
  • Mayao Luo
  • Shaoyu Wu
  • Anli Lai
  • Yang Sun
  • Qinyuan Hu
  • Yi He
  • Jing TianEmail author
Knee Revision Surgery



To assess the infection eradication rate when using two types of articulating spacers (prosthetic articulating spacers and all-cement articulating spacers) in two-stage revision of infected total knee arthroplasty (TKA).


We comprehensively searched PubMed, Embase, and the Cochrane Library databases and performed a systematic review and meta-analysis of retrospective comparative studies assessing two types of articulating spacers. A quality assessment of the included studies was performed following the STROBE statement.


Thirty retrospective studies, including a total of 821 knees, were identified. The pooled infection control rates in stage I were as follows: 0.98 (95% confidence interval [CI], 0.97 to 1.00) and 0.98 (95% CI, 0.96 to 0.99) for the prosthetic articulating spacer group and all-cement articulating spacer group, respectively. The pooled postoperative reinfection rate was 0.05 (95% CI, 0.03 to 0.08) for the prosthetic spacer group and 0.03 (95% CI, 0.01 to 0.06) for the all-cement spacer group. Results of the subgroup analyses showed that the weight of the antibiotic cement, antibiotic type, mean period of spacers in situ, postoperative antibiotic treatment period, and postoperative antibiotic treatment approach had no effect on the reinfection rates (p < 0.05).


Compared to all-cement articulating spacers, articulating spacers containing bio-inert materials have a similar infection control rate but a higher postoperative reinfection rate. Although the 95% CIs of reinfection rates in the two groups overlapped, our results indicate that articulating spacers containing bio-inert materials may be associated with higher reinfection rates and poorer clinical outcomes than all-cement articulating spacers.


Total knee arthroplasty Total knee replacement Revision TKA Periprosthetic infection Articulating spacer Bio-inert material 



We acknowledge Professor Jing Tian for selecting the topic and offering valuable suggestions. His instruction was a great help for the completion of our study.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Qiang Yu
    • 1
  • Mayao Luo
    • 2
  • Shaoyu Wu
    • 2
  • Anli Lai
    • 2
  • Yang Sun
    • 2
  • Qinyuan Hu
    • 2
  • Yi He
    • 2
  • Jing Tian
    • 1
    Email author
  1. 1.Department of Orthopaedics, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina
  2. 2.The Second Clinical Medical School, Zhujiang HospitalSouthern Medical UniversityGuangzhouChina

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