Antibiotic loading gives the spacer a drug-delivery role in addition to its structural role. After implantation, the antibiotic diffuses from the cement into surrounding tissue, creating local antimicrobial exposure at the surgical site. This dual action is central to staged infection management: the device occupies the space while the loaded cement supports treatment before definitive reconstruction.
Greater antibiotic content may support elution, but spacer design cannot be judged by drug release alone. The cement must remain sufficiently functional as it preserves joint alignment, limb length, and soft-tissue tension. Biocompatibility is another constraint, so the selected design balances local antimicrobial delivery, mechanical performance, and tissue compatibility rather than optimizing one property in isolation.
By occupying the surgical site, the spacer helps maintain the geometry needed for later reconstruction. In particular, it can preserve joint alignment, limb length, and soft-tissue tension while infection treatment proceeds. These mechanical effects provide a temporary bridge between prosthesis removal and definitive reconstruction, rather than serving only as a carrier for antibiotics.
They are commonly used after surgeons remove an infected joint prosthesis during the first stage of a two-stage revision arthroplasty. An antibiotic-loaded device can then occupy the surgical site while infection management continues. Once infection control permits definitive reconstruction, the temporary spacer's role ends and the joint can proceed to the next reconstructive stage.
Preparation centers on shaping moldable PMMA bone cement for the surgical site and incorporating antibiotics into the cement when local delivery is part of treatment. The resulting design must fit the temporary mechanical purpose while allowing drug diffusion into surrounding tissue. Choice of shape and antibiotic content therefore connects the operative goal with elution, strength, and biocompatibility requirements.
Because it is used between prosthesis removal and definitive reconstruction, the spacer is designed for an interim role rather than permanent joint replacement. Its value lies in maintaining space and selected mechanical relationships while local antimicrobial treatment takes place. This staged function allows reconstruction to be deferred until infection control permits the next procedure.