Two-Stage Exchange Knee Arthroplasty: Static Spacers
Antibiotic spacers are an important tool in the management of periprosthetic joint infection. The concept of spacers has evolved from a static block in which the knee is immobilized in full extension to more conforming articulating surfaces that allow more knee motion, in an attempt to improve patients’ quality of life before and after reimplantation. Static spacers are still indicated in knees with significant bone and soft tissue compromise to avoid complications related to mobility in the absence of the proper amount of constraint. Increasing the amount of antibiotics added to the cement results in a higher and longer elution but could lead to potential systemic toxicity. It also reduces the mechanical strength of cement which becomes a concern if mobility and weight bearing are to be permitted. The ideal dose of antibiotics to be mixed with cement remains unclear. Large doses have been demonstrated to be clinically safe, but have not shown to be cost-effective in providing better infection control.
KeywordsPorosity Migration Toxicity Creatinine Mold
- 13.Greene N, Holtom PD, Warren CA, et al. In vitro elution of tobramycin and vancomycin polymethylmethacrylate beads and spacers from Simplex and Palacos. Am J Orthop (Belle Mead NJ). 1998;27:201–5.Google Scholar
- 14.Chang Y, Chen WC, Hsieh PH, et al. In vitro activities of daptomycin-, vancomycin-, and teicoplanin-loaded polymethylmethacrylate against methicillin-susceptible, methicillin-resistant, and vancomycin-intermediate strains of Staphylococcus aureus. Antimicrob Agents Chemother. 2011;55:5480–4.PubMedCrossRefGoogle Scholar
- 27.Hsieh PH, Chang YH, Chen SH, et al. High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days. J Orthop Res. 2006;24:1615–21.PubMedCrossRefGoogle Scholar