Are Preformed Articulating Spacers Superior To Surgeon-Made Articulating Spacers in the Treatment Of PJI in THA? A Literature Review

Mustafa Citak*, 1, Bassam A. Masri2, Bryan Springer3, Jean-Noel Argenson4, Daniel O. Kendoff1
1 Department of Orthopaedic Surgery, Helios-Endo Klinik Hamburg, Hamburg, Germany
2 Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
3 Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center, Charlotte, NC, USA
4 Department of Orthopaedic Surgery, The Institute for Locomotion, Aix-Marseille University, Hôpital Sainte Marguerite, Marseille, France

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© Citak et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstrasse 2, 22767 Hamburg, Germany; Tel: +49 176 61987317; Fax: +49 40 3197; E-mail:


Background and Purpose:

Antibiotic-loaded cement spacers are typically manufactured by surgeons in the operating room. However, if the infecting organism is known preoperatively, the cement spacer can be fabricated (Spacer-G® or the InterSpace® Hip) in advance. It is unclear if preformed hip spacers are superior to surgeon-made hip spacers in the treatment of periprosthetic joint infection following primary THA.


A literature review of the peer-reviewed literature indexed by MEDLINE and Embase was performed to identify studies reporting the outcomes of preformed and surgeon-made hip spacers in the treatment of infection following primary total hip arthroplasty (THA). A total of 43 articles met the inclusion criteria and were included in the analysis to compare the reinfection rate, Harris Hip Score (HHS) and spacer complication rates between surgeon-made and preformed hip spacers.

Results and Interpretation:

The analyzed studies included a total number of 1631 infected THA cases (n=1027 surgeonmade; n=604 preformed spacers). We found similar reinfection rates (6.0% surgeon-made, and 5.5% preformed spacers) and similar mean HHS at latest follow-up after reimplantation (HHS=84.3 surgeon-made, and HHS=81.8 preformed spacers) between both groups. However, patients treated with a surgeon-made articulating spacer had a higher spacer fracture rate compared to preformed articulating spacer. The use of preformed articulating spacers in the treatment of infected THA is not superior to surgeon-made articulating spacers regarding infection control and functional outcomes. However, the use of surgeon-made antibiotic spacers increased the risk of spacer fracture.

Keywords: Articulating spacer, preformed spacer, periprosthetic infection, surgeon-made spacer..