ICJR Interviews: Should Surgeons Use Articulating or Static Spacers?

    The question of which type of spacer – articulating or static – should be used in the first stage of a 2-stage exchange in an infected total knee arthroplasty (TKA) is still unanswered.

    A multicenter, randomized controlled trial is attempting to provide some clarity around this issue, and in the initial data analysis, articulating spacers are proving to be the better option, at least for range of motion (ROM).

    Gregory K. Deirmengian, MD, from The Rothman Institute in Philadelphia, Pennsylvania, said that a key issue with articulating spacers is the higher cost when compared with static spacers.

    To justify the cost, articulating spacers would have to show significant benefits over static spacers in terms of patient outcomes.

    So far, the report of data from 52 patients who met MusculoSkeletal Infection Society criteria for periprosthetic joint infection following a primary TKA showed significant improvement in ROM at a mean of 1.7 years after reimplantation – 15° more ROM for articulating versus static spacers.

    In addition, articulating spacers showed a trend toward decreased bone loss and infection recurrence and better functional outcome scores compared with static spacers, but the differences were not statistically significant.

    For that reason, the researchers are continuing to enroll patients in the hopes of providing definitive answers.

    Click the image above to hear Dr. Deirmengian’s comments on the study, “Articulating vs. Static Spacers in the Management of Periprosthetic Knee Infection: A Randomized Clinical Trial” (Paper 238), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Susan Doan Johnson; Director and Post Production: Charles J. Maynard