Antibiotic cement spacers in total hip and total knee arthroplasty: Problems, pitfalls, and avoiding complications

With the increasing number of total hip (THA) and knee arthroplasties (TKA) performed with expanding indications and at a younger age, there continues to be a low risk of periprosthetic sepsis in association with these surgeries. The incidence of infection in THA/TKA ranges for 0.3% to 3 %. While sepsis is a rare complication, the management from both patient and surgeon perspective are challenging, often require a prolonged course of treatment, and may lead to complications. The diagnosis and management of periprosthetic sepsis has evolved with the current standard of care and management based upon the useful classification of Gustilo et al [21, 25]. The use of antibiotic impregnated cement beads [19] and spacers as local delivery devices to treat periprosthetic infections in either a single stage [3] or two-stage surgery [12, 17, 18] has evolved and become popular over recent years. Frequently, reports of periprosthetic sepsis do not address antibiotic spacer complications.