Antibiotic-loaded cement spacers - lessons learned from the past 20 years.

INTRODUCTION: The use of antibiotic-impregnated cement spacers is an established method in the treatment of periprosthetic hip and knee joint infections. Over the past 20 years, the indications for spacer implantation have expanded, and various modified surgical techniques have been proposed to manage difficult anatomical situations. To ensure clinical success, knowledge about the cement impregnation and the pharmacokinetic properties of antibiotic-loaded bone cement is an indispensable premise. AREAS COVERED: In this review, techniques for the fabrication of cement spacers, the incorporation of antibiotics into bone cement, elution kinetics, the clinical performance of spacers, individualized surgical techniques as well as possible postoperative complications are presented. Moreover, the possibility of bacterial colonization of cement spacers during the interim phase which might lead to persistence of infection is also discussed. EXPERT COMMENTARY: The use of articulating spacers is established in hip surgery. However, in knee surgery it is still debated whether articulating or static spacers provide more advantages. The concern about the possible colonization of antibiotic-loaded spacers during the interim phase does not seem to be actually substantiated by hard scientific data due to the lack of important information in the published studies.