Success rates, characteristics, and costs of articulating antibiotic spacers for total knee periprosthetic joint infection

Background: The optimal type, characteristics, and success rates of articulating antibiotic spacers used during total knee arthroplasty (TKA) periprosthetic joint infection (PJI) have not been well defined in a single series. We sought to (1) determine the success rate for three unique spacer constructs and (2) evaluate any microbiological, surgical, or patient characteristics that would influence the success rate. Methods: We retrospectively reviewed patients who underwent a two-stage exchange for a TKA PJI with a prefabricated spacer (PREFAB), home-made mold (MOLD), or autoclaved femoral component (AUTOCL). Patient demographics, microbiology data, amount of antibiotic in each spacer construct, postoperative course, and infection cure outcomes were evaluated. Results: The success rate for being infection free at final follow-up without the need for further reoperation for infection was 82.7% in the PREFAB group, 88.4% in the MOLD group, and 79.4% in the AUTOCL group (p = 0.54). There was no clear statistical link between raw quantities of vancomycin and aminoglycoside in the spacer and a successful outcome. The surgeon's own intraoperatively created mold group had the lowest construct cost at a mean $1341.00 +/- 889.10 (p < 0.0001) per construct, while the commercial cement molds had the highest mean cost at $5439.00 +/- 657.80 (p < 0.0001). Conclusions: There was no statistically significant difference in the success rates between the antibiotic spacer types. The surgeon's own intraoperative mold had the least overall associated cost. (C) 2017 Elsevier B.V. All rights reserved.