Static vs Articulating Spacers: Systematic Review in the Management of Total Hip Arthroplasty Periprosthetic Joint Infection

Aims and background: This systematic review aimed to compare static and articulating spacers in two-stage revision hip arthroplasty for the management of periprosthetic joint infection (PJI) following total hip arthroplasty (THA).Methods: A strategic keyword search of MEDLINE, Embase, Web of Science, and Cochrane retrieved studies examining two-stage revision with static or articulating spacers following THA PJI prior to September 3, 2024.Two independent reviewers screened articles for predefined inclusion and exclusion criteria.Clinical outcomes, spacer-related complications, and functional outcomes were extracted for analysis.Results: In total, 1,403 articles were screened; final analysis included 49 studies and 4,307 spacers.Nine studies directly compared static and articulating spacers; 40 studies included articulating spacers only.Articulating and static spacers had similar rates of infection eradication, but articulating spacers had slightly higher mechanical complications and shorter hospital stays.Functional scores, like the Harris Hip Score (HHS), were similar amongst spacer types.Conclusion: While static and articulating spacers remain viable options in two-stage THA revisions for PJI, articulating spacers demonstrate a promising direction for eradicating PJI while maintaining quality of life.Further studies directly comparing static and articulating spacers are needed to clarify their potential benefits and disadvantages.Clinical significance: In two-stage THA revision for PJI, articulating spacers may justify higher upfront costs through shorter hospital length of stay (LOS) and greater patient satisfaction compared to static spacers.