➤ Infection at the site of a total joint arthroplasty can be classified into four basic categories: Type I (early postoperative), Type II (late chronic), Type III (acute hematogenous), and Type IV (positive intraoperative cultures with clinically unapparent infection).
➤ The current standard of care for late chronic infection is considered to be two-stage revision arthroplasty including removal of the prosthesis and cement, thorough débridement, placement of an antibiotic-impregnated cement spacer, a course of intravenous antibiotics, and a delayed second-stage revision arthroplasty.
➤ The choice of the spacer, either articulating or nonarticulating, is based on many factors, including the amount of bone loss, the condition of the soft tissues, the need for joint motion, the availability of prefabricated spacers or molding methods, and antibiotic selection.
➤ Current data have demonstrated that the use of antibiotic-impregnated cement spacers has improved the outcomes of the treatment of infection associated with total joint arthroplasty