Aims Periprosthetic joint infection (PJI) is a challenging complication of any arthroplasty procedure. We reviewed our use of static antibiotic-loaded cement spacers (ABLCSs) for staged management of PJI where segmental bone loss, ligamentous instability, or soft-tissue defects necessitate a static construct. We reviewed factors contributing to their failure and techniques to avoid these complications when using ABLCSs in this context. Methods A retrospective analysis was conducted of 94 patients undergoing first-stage revision of an infected knee prosthesis between September 2007 and January 2020 at a single institution. Radiographs and clinical records were used to assess and classify the incidence and causes of static spacer failure. Of the 94 cases, there were 19 primary total knee arthroplasties (TKAs), ten revision TKAs (varus-valgus constraint), 20 hinged TKAs, one arthrodesis (nail), one failed spacer (performed elsewhere), 21 distal femoral endoprosthetic arthroplasties, and 22 proximal tibial arthroplasties. Results A total of 35/94 patients (37.2%) had spacer-related complications, of which 26/35 complications (74.3%) were because of mechanical failure of the spacer construct, while 9/35 (25.7%) were due to recurrence of infection. Risk factors for internal failure were a construct where the total intramedullary spacer length was less than twice the length of the central osseous defect (p = 0.009), where proximal or distal intraosseous spacer contact was < 10%, and after tibial tubercle osteotomy (p = 0.005). The incidence of spacer complications significantly increased the time to second stage: mean 157 days (42 to 458) in those without complications versus 227 days (11 to 528) with complications (p = 0.014). Conclusion The failure rate of static antibiotic-loaded cement spacers is much higher than anticipated. Complications of the spacer significantly increased the time to second-stage revision. The risk of mechanical failure is significantly increased if the spacer is less than double the size of the segmental defect, or if inadequate reinforcement is inserted into the residual bone. These findings serve as a guide for surgeons to avoid mechanical complications with static spacers.

中文翻译：

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感染膝关节置换术和内假体的分期翻修。


目的 假体周围关节感染 （PJI） 是任何关节置换术中具有挑战性的并发症。我们回顾了我们使用静态抗生素负载水泥垫片 （ABLCS） 对 PJI 进行分期管理，其中节段性骨质流失、韧带不稳定或软组织缺损需要静态结构。我们回顾了导致其失败的因素以及在这种情况下使用 ABLCS 时避免这些并发症的技术。方法 对 2007 年 9 月至 2020年1月期间在单一机构接受感染膝关节假体第一阶段翻修的 94 例患者进行了回顾性分析。使用 X 光片和临床记录对静态垫片失效的发生率和原因进行评估和分类。在这 94 例病例中，有 19 例原发性全膝关节置换术 （TKA）、10 例翻修 TKA（内翻-外翻约束）、20 例铰链式 TKA、1 例关节融合术（钉）、1 例垫片失败（在其他地方进行）、21 例股骨远端内假体关节置换术和 22 例胫骨近端关节置换术。结果 35/94 例患者 （37.2%） 出现垫片相关并发症，其中 26/35 例 （74.3%） 是由于垫片结构的机械失效，9/35 （25.7%） 是由于感染复发。内部失败的危险因素是髓内总垫片长度小于中央骨缺损长度的两倍的结构 （p = 0.009），其中近端或远端骨内垫片接触为 < 10%，以及胫骨结节截骨后 （p = 0.005）。垫片并发症的发生率显著增加了进入第二阶段的时间：无并发症的患者平均为 157 天 （42 至 458），而有并发症的患者为 227 天 （11 至 528） （p = 0.014）。 结论 静态抗生素负载水泥垫片的故障率远高于预期。垫片的并发症显著增加了第二阶段翻修的时间。如果垫片小于节段性缺损大小的两倍，或者如果插入残余骨的加固不足，则机械失效的风险会显著增加。这些发现可为外科医生提供指导，以避免静态垫片的机械并发症。