Cement Spacers in Periprosthetic Joint Infection

TO THE EDITOR—We congratulate Dr Iarikov and other authors of the article “Choice and Doses of Antibacterial Agents for Cement Spacers in Treatment of Prosthetic Joint Infections: Review of Published Studies” [1] for exploring an important area in orthopedics. Periprosthetic joint infection (PJI) continues to place an immense psychological and economic burden on patients and the healthcare system. Thus, the scholarly desire of representatives of the US Food andDrugAdministration to address issues related to this dreaded complication is both logical and commendable. However, the conclusions drawn by Iarikov [1] related to antibiotic-impregnated cement spacers is both concerning and unfounded. We as clinicians, and scholars such as the authors, need to begin questioning the rationale and foundation behind many of our practices. The latter is a welcome step in delivery of costeffectivemedical care. The reality ofmedicine is such that not every aspect of care can be subjected to scientific scrutiny without placing patients at risk. In fact, the basic tenet of the “hypothesis” posed by the authors has never been subjected to a level 1 study either. There is no randomized, prospective study to show that systemic administration of antibiotics is “necessary” during management of PJI. It is only clinical experience and wisdom that calls for such practice. Polymethyl methacrylate is an important and effective clinical tool for local delivery of antibiotics and in surgical management of PJI [2–4]. The latter is based on large body of evidence and clinical wisdom. We fully agree with the authors in that no level 1 study exists that has proven the efficacy of antibiotic-impregnated cement spacers in management of PJI. The rationale for adding antibiotics to spacers (granted using different regimen and doses) is in an effort to deliver high doses of local antibiotics, which would then obviate the need for administration of