title: Are Preformed Articulating Spacers Superior To Surgeon-Made Articulating Spacers in the Treatment Of PJI in THA? A Literature Review.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Helios-Endo Klinik Hamburg, Hamburg, Germany.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Citak
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Bassam A
authors.initials: BA
authors.lastname: Masri
authors.affiliation: Department of Orthopaedic Surgery, OrthoCarolina Hip and Knee Center, Charlotte, NC, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Springer
authors.affiliation: Department of Orthopaedic Surgery, The Institute for Locomotion, Aix-Marseille University, Hôpital Sainte Marguerite, Marseille, France.
authors.forename: Jean-Noel
authors.initials: JN
authors.lastname: Argenson
authors.affiliation: Department of Orthopaedic Surgery, Helios-Endo Klinik Hamburg, Hamburg, Germany.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Kendoff
keywords: Articulating spacer; periprosthetic infection; preformed spacer; surgeon-made spacer.