Choice and Doses of Antibacterial Agents for Cement Spacers in Treatment of Prosthetic Joint Infections: Review of Published Studies

Background. Addition of antibacterial drugs to interim antibacterial cement spacers (ACSs) is considered to be standard of care for surgical revision in prosthetic joint infections (PJIs). We reviewed published studies evalu-ating the choice and doses of antibacterials in spacers. Methods. We conducted a PubMed search of all clinical study reports evaluating the use of ACSS in a 2-stage hip or knee arthroplasty for treatment of PJI (1988 through August 2011). The trial design, antibacterials used, and end points studied were analyzed. Results. No randomized trials were found comparing either ACSs with different concentrations of antibacteri-als or ACSs with or without antibacterials. Most of the studies were uncontrolled and used various time points to evaluate the outcome. Twenty publications that reported doses of antibacterials in spacers and had a follow-up of ≥24 months after the second stage were selected for review. Most ACSs included vancomycin and aminoglyco-sides. The doses of aminoglycosides and vancomycin ranged from 0.25 to 4.8 g and from 1 to 4 g, respectively, per 40 g of cement. No association between reported eradication of the infection and antibacterial load was found. Conclusions. Published data do not allow evaluation of whether antibacterials in temporary cement spacers provide additional benefits in the treatment of PJI, compared with systemic antibacterials, and are not sufficient to support recommendations on dosages. Complications of ACSs have not been consistently analyzed. Prospectiv