Real Component Spacers for Two-Stage Exchange Demonstrate Low Bacterial Colonization

Overview

Journal Arthroplast Today

Publisher Elsevier

Date 2025 Mar 11

PMID 40066236

Authors

Logan E Finger

Alan E Wilson

Brandon K Couch

Alexander P Hoffman

Confidence Njoku-Austin

Brian A Klatt

Michael J OMalley

Johannes F Plate

Affiliations

Soon will be listed here.

Abstract

Background: Patients undergoing two-stage exchange arthroplasty for chronic periprosthetic joint infection (PJI) with real component spacers (RC) benefit from improved function. While RCs have similar reinfection rates compared to other spacer types, concerns exist regarding the potential for bacterial colonization and biofilm formation on the RC metal components.

Methods: Patients who completed two-stage exchange arthroplasty for treatment of Musculoskeletal Infection Society-defined hip or knee PJI were included and explanted spacer components were sent for sonication fluid culture (SFC). Medical records were reviewed for demographics, laboratory values, culture results, and clinical outcome data including 90-day reoperations and all-cause revisions.

Results: A total of 112 patients (57 hips and 64 knees) were included. Sixty (49.6%) patients received an articulating cement spacer (AC), 35 (28.9%) received an RC, and 26 (21.5%) received a static spacer (SS). No positive SFCs were identified with RC compared to 18.3% with AC and 11.5% with SS ( = .01). The number of positive tissue cultures was similar (RC 8.6%, AC 1.7%, SS 3.8%; = .18). No patients who received an RC required repeat debridement within 90 days, while 11.8% with AC and 4.5% with SS required repeat debridement ( = .14). The difference in the rate of all-cause revision and revision due to recurrent infection among the 3 groups was found to be similar ( = .43 and = .50, respectively).

Conclusions: RC showed fewer SFCs when compared to AC and SS, though there was no significant difference in positive tissue cultures, reoperation within 90 days, all-cause revision, or revision due to recurrent infection among the groups.

References

Lueck E, Schlaepfer T, Schildberg F, Randau T, Hischebeth G, Jaenisch M . The psychological burden of a two-stage exchange of infected total hip and knee arthroplasties. J Health Psychol. 2020; 27(2):470-480. DOI: 10.1177/1359105320948583. View

Marson B, Walters S, Bloch B, Sehat K . Two-stage revision surgery for infected total knee replacements: reasonable function and high success rate with the use of primary knee replacement implants as temporary spacers. Eur J Orthop Surg Traumatol. 2017; 28(1):109-115. DOI: 10.1007/s00590-017-2016-7. View

Peng G, Liu Q, Guan Z, Liu M, Sun X, Zhu X . Diagnostic accuracy of sonication fluid cultures from prosthetic components in periprosthetic joint infection: an updated diagnostic meta-analysis. J Orthop Surg Res. 2023; 18(1):175. PMC: 9996915. DOI: 10.1186/s13018-023-03662-3. View

Goltz D, Sutter E, Bolognesi M, Wellman S . Outcomes of Articulating Spacers With Autoclaved Femoral Components in Total Knee Arthroplasty Infection. J Arthroplasty. 2018; 33(8):2595-2604. DOI: 10.1016/j.arth.2018.03.059. View

Trampuz A, Piper K, Jacobson M, Hanssen A, Unni K, Osmon D . Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007; 357(7):654-63. DOI: 10.1056/NEJMoa061588. View

Karas V, Rutherford R, Herschmiller T, Plate J, Bolognesi M, Joyce M . Flash Sterilization and Component Reimplantation Is a Viable Option for Articulating Antibiotic Spacers in Periprosthetic Knee Infections. J Knee Surg. 2020; 34(10):1092-1097. DOI: 10.1055/s-0040-1701518. View

Natsuhara K, Shelton T, Meehan J, Lum Z . Mortality During Total Hip Periprosthetic Joint Infection. J Arthroplasty. 2019; 34(7S):S337-S342. DOI: 10.1016/j.arth.2018.12.024. View

Roof M, Baylor J, Bernstein J, Antonelli B, Kugelman D, Egol A . Comparing the Efficacy of Articulating Spacer Constructs for Knee Periprosthetic Joint Infection Eradication: All-Cement vs Real-Component Spacers. J Arthroplasty. 2021; 36(7S):S320-S327. DOI: 10.1016/j.arth.2021.01.039. View

Kalore N, Maheshwari A, Sharma A, Cheng E, Gioe T . Is there a preferred articulating spacer technique for infected knee arthroplasty? A preliminary study. Clin Orthop Relat Res. 2011; 470(1):228-35. PMC: 3237967. DOI: 10.1007/s11999-011-2037-1. View

10.

Kildow B, Della-Valle C, Springer B . Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection. J Arthroplasty. 2020; 35(3S):S24-S30. DOI: 10.1016/j.arth.2019.10.051. View

11.

Spinarelli A, Bizzoca D, Moretti L, Vicenti G, Garofalo R, Moretti B . The autoclaving and re-implantation of an infected prosthesis as a spacer during resection knee arthroplasty: a systematic review. Musculoskelet Surg. 2021; 106(2):111-125. PMC: 9130160. DOI: 10.1007/s12306-021-00722-x. View

12.

Corona P, Vicente M, Carrera L, Rodriguez-Pardo D, Corro S . Current actual success rate of the two-stage exchange arthroplasty strategy in chronic hip and knee periprosthetic joint infection. Bone Joint J. 2020; 102-B(12):1682-1688. DOI: 10.1302/0301-620X.102B12.BJJ-2020-0792.R1. View

13.

Veltman E, Moojen D, Poolman R . Improved patient reported outcomes with functional articulating spacers in two-stage revision of the infected hip. World J Orthop. 2020; 11(12):595-605. PMC: 7745492. DOI: 10.5312/wjo.v11.i12.595. View

14.

Zhang Q, Ding B, Wu J, Dong J, Liu F . Sonication fluid culture of antibiotic-loaded bone cement spacer has high accuracy to confirm eradication of infection before reimplantation of new prostheses. J Orthop Surg Res. 2021; 16(1):377. PMC: 8199841. DOI: 10.1186/s13018-021-02520-4. View

15.

Wichern E, Zielinski M, Ziemba-Davis M, Meneghini R . Contemporary 2-Stage Treatment of Periprosthetic Hip Infection with Evidence-Based Standardized Protocols Yields Excellent Results: Caveats and Recommendations. J Arthroplasty. 2020; 35(10):2983-2995. DOI: 10.1016/j.arth.2020.05.028. View

16.

Kugelman D, Roof M, Egol A, Guanche I, Chen A, Schwarzkopf R . Comparing Articulating Spacers for Periprosthetic Joint Infection After Primary Total Hip Arthroplasty: All-Cement Versus Real-Component Articulating Spacers. J Arthroplasty. 2022; 37(7S):S657-S663. DOI: 10.1016/j.arth.2021.12.008. View

17.

Sorli L, Puig L, Torres-Claramunt R, Gonzalez A, Alier A, Knobel H . The relationship between microbiology results in the second of a two-stage exchange procedure using cement spacers and the outcome after revision total joint replacement for infection: the use of sonication to aid bacteriological analysis. J Bone Joint Surg Br. 2012; 94(2):249-53. DOI: 10.1302/0301-620X.94B2.27779. View

18.

Parvizi J, Gehrke T . Definition of periprosthetic joint infection. J Arthroplasty. 2014; 29(7):1331. DOI: 10.1016/j.arth.2014.03.009. View

19.

Springer B, Cahue S, Etkin C, Lewallen D, McGrory B . Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today. 2017; 3(2):137-140. PMC: 5485227. DOI: 10.1016/j.artd.2017.05.003. View

20.

Zamora T, Garbuz D, Greidanus N, Masri B . An articulated spacer made of new primary implants in two-stage exchange for infected total knee arthroplasty may provide durable results. Bone Joint J. 2020; 102-B(7):852-860. DOI: 10.1302/0301-620X.102B7.BJJ-2019-1443.R1. View