Antibiotic spacer for periprosthetic infection - how long can they be left in?

Antibiotic cement spacer retention for chronic shoulder infection after minimum 2-year follow-up

These authors reviewed the long-term functional and patient-reported outcomes data of 22 patients with retained antibiotic cement spacers. All patients were originally offered a 2-stage revision and declined. Twelve patients had a minimum follow-up of 2 years (average 5.6 years) and were included in their cohort. Mean age was 70.7, 8/12 patients were female, and the average body mass index was 27.8. 

Eight patients had spacer placement for chronic shoulder arthroplasty infections, whereas 4 patients had spacer placement for chronic osteomyelitis of the proximal humerus. 

No patients were currently being treated with suppressive antibiotics. One patient had negative cultures at the time of antibiotic spacer placement. The most common organisms were Cutibacterium (6), Staphylococcus epidermidis (6), and methicillin-resistant Staphylococcus aureus (4), with 4 patients growing more than 1 species.

 

The average ASES score was 54, QuickDASH was 45, and VAS score 2.8. Average active range of motion was 68 of forward elevation and 35 of external rotation.

Three patients required revision of their antibiotic spacer because of continued pain and positive cultures on joint aspiration after completion of antibiotics, resulting in a reoperation rate of 25%.

Comment: A single stage exchange remains our primary approach for shoulder periprosthetic infections from Cutibacterium or Coagulase negative staph. We find spacers particularly helpful (1) in cases where a single stage exchange has failed or in cases with draining sinuses, (2) for infections by organisms other than Cutibacterium or Coagulase negative staph, and (3) for cases of suspected metal allergy . It is important to use a spacer with a metal reinforcement to prevent fracture on removal. It is also important to find the right balancer in stem fixation, so that the spacer is not loose on one hand and can still be removed without damaging the shaft on the other. 

Here are the x-rays of a man with a retained spacer after multiple failed procedures for a Cutibacterium periprosthetic infection.

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