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Role of bacterial colonisation of vancomycin–gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication



In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis.

Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication.


A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories:

  1. A.

    Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples.

  2. B.

    Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples.

  3. C.

    Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples.


A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%.

Spacers were colonised in all cases by low virulent micro-organisms.


In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.

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Fig. 1


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The authors did not receive support from any organisation for the submitted work.

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The manuscript was written by Sandra Huguet, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Sandra Huguet.

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The authors have no relevant financial or nonfinancial interests to disclose.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Fundació Assistencial Mútua Terrassa in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

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Huguet, S., Bernaus, M., Gómez, L. et al. Role of bacterial colonisation of vancomycin–gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. Eur J Orthop Surg Traumatol (2021).

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  • Sonication
  • Spacer
  • Revision surgery
  • Two-stage surgery
  • Periprosthetic joint infection