The Use of Static Spacers in Periprosthetic Knee Infections

Abstract

Periprosthetic knee infection is a severe and not infrequent complication, with an incidence ranging from 0.4 to 2.5% for primary TKA and 4 to 8% for revision surgery. For acute infection, prosthesis removal is not necessary and a simple DAIR should be performed in association with replacement of the polyethylene insert. For subacute or chronic infection, prosthetic replacement is necessary, and two methods of management can be discussed: single-stage or two-stage exchange arthroplasty. Although single-stage exchange knee arthroplasty is possible in certain specific cases, prosthetic replacement in two stages is currently considered as standard treatment. During two-stage exchange arthroplasty, the first stage is to remove all prosthetic material with thorough debridement of the periprosthetic tissues. Multiple tissue samples are collected during the first stage debridement. An antibiotic-impregnated cement spacer is positioned in place of the TKA implants. Later, once the infection is controlled, prosthesis reimplantation is performed during the second stage. The optimal delay before the second surgery is still debated. The use of a cement spacer is practically systematic in the treatment of TKA infection, because it allows the preservation of sufficient joint space during the intermediate period without a prosthesis, which allows maintenance of the space for reimplantation of the new prosthesis during the second stage surgery. There are two types of spacer commonly used: static spacer or dynamic spacer. Both types of spacer have advantages and disadvantages.