Articles | Volume 10, issue 4
https://doi.org/10.5194/jbji-10-243-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-10-243-2025
© Author(s) 2025. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Original full-length article
| 
30 Jul 2025
Original full-length article |
| 30 Jul 2025
| 30 Jul 2025
No difference in failure between static, articulating, and prosthetic low-friction spacers for periprosthetic joint infection of total knee arthroplasty
Michael F. Shannon
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Timothy Edwards
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA
Timothy Maurer
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA
Andrew J. Frear
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Victoria R. Wong
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Shaan Sadhwani
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA
Clair Smith
School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15213, USA
Anthony Kamson
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA
Brian Omslaer
Department of Orthopaedic Surgery, UPMC Central PA, Harrisburg, PA 17109, USA
Christian Cisneros
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Andrew Gordon
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Akeem Williams
School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Neel B. Shah
Division of Infectious Disease, Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
Arthritis and Arthroplasty Design Group, The Bone and Joint Center, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
Department of Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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Samuelson E. Osifo, Adrian Santana, Michael F. Shannon, Victoria R. Wong, Caroline F. Tyndall, Christian Cisneros, Niosha Parvizi, Brian A. Klatt, Johannes F. Plate, Nicolas S. Piuzzi, and Kenneth L. Urish
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Fungal organisms are conventionally estimated to account for 1 % –2 % of periprosthetic joint infection (PJI) cases, although diagnostic and reporting limitations may result in systematic underestimation. Using a quantitative missing-data sensitivity analysis across 23 studies encompassing 28 253 PJI cases, we estimated an adjusted Candida PJI proportion of approximately 5 %, increasing to nearly 10 % in chronic or refractory infections.
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This retrospective study compared debridement and implant retention failure for three types of acute knee replacement infection and analyzed outcomes for patients in a cohort with low medical risk. No differences in failure rate were seen between types in the overall sample or “optimal” cohort. Staphylococcus aureus was less common in later infection, while Streptococcus was less frequent in earlier infection. In an optimal patient, similar outcomes between types may suggest that medical factors do not alter risk.
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Fungal organisms are conventionally estimated to account for 1 % –2 % of periprosthetic joint infection (PJI) cases, although diagnostic and reporting limitations may result in systematic underestimation. Using a quantitative missing-data sensitivity analysis across 23 studies encompassing 28 253 PJI cases, we estimated an adjusted Candida PJI proportion of approximately 5 %, increasing to nearly 10 % in chronic or refractory infections.
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J. Bone Joint Infect., 10, 225–235, https://doi.org/10.5194/jbji-10-225-2025, https://doi.org/10.5194/jbji-10-225-2025, 2025
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This retrospective study compared debridement and implant retention failure for three types of acute knee replacement infection and analyzed outcomes for patients in a cohort with low medical risk. No differences in failure rate were seen between types in the overall sample or “optimal” cohort. Staphylococcus aureus was less common in later infection, while Streptococcus was less frequent in earlier infection. In an optimal patient, similar outcomes between types may suggest that medical factors do not alter risk.
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Periprosthetic joint infection (PJI) is one of the most challenging complications following total joint arthroplasty. PJI infections are primarily caused by antibiotic-tolerant biofilms on the surface of the implant. Bacterial toxin antitoxin systems are believed to play a critical role in biofilm antibiotic tolerance and resistance. The objective of this study was to identify the role of the S. aureus toxin YoeB in biofilm formation, antibiotic susceptibility, and virulence.
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Short summary
We retrospectively compared outcomes of two-stage revision with three common spacer types. No significant difference in failure rate was seen across groups, contributing evidence of similar efficacy. Articulating spacers showed a greater range of motion than static spacers, and static spacers were associated with a higher adverse event rate, directly showing potential advantages and disadvantages of each variant. A trend toward a longer interstage duration for prosthetic spacers may reflect greater functionality.
We retrospectively compared outcomes of two-stage revision with three common spacer types. No
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