Comparative evaluation of clinical outcomes of using articulating and non-articulating cement spacers in the first stage of treatment of periprosthetic infection

Periprosthetic joint infection (PJI) remains one of the most serious complications in modern orthopedic practice, particularly after knee arthroplasty. The incidence of PJI ranges from 0.5–2.0% after primary knee arthroplasty and up to 22% after revision procedures. In Kazakhstan, 403 cases of PJI involving large joints were officially registered in 2023.Objective.This study aims to evaluate the clinical outcomes of articulating and static (non-articulating) cement spacers used during the first stage of two-stage revision knee arthroplasty for PJI.Methods. For a randomized study, 20 patients were selected, divided into 2 groups of 10 people. The first group received an articulating cement spacer in the knee joint, while the second group received a non-articulating (static) cement spacer. Both groups included 8 women and 2 men. Median age was 64 years (IQR: 57–69) in the articulating spacer group and 62 years (IQR: 56.5–67) in the non-articulating group.Clinical and radiological evaluations were conducted 12 months postoperatively.Results.Our study found no significant differences in baseline characteristics, hospital stay, or duration of surgery. Functional outcomes were significantly better in the articulating group based on Knee Society Score (knee: 82 vs. 38.2; function: 70 vs. 35; p< 0.001) and Oxford Knee Score (35 vs. 25; p=0.0014). Radiographic analysis showed cement-bone lucency in100% of non-articulating spacers and 40% of articulating spacers (p = 0.0034). At 12 months, PJI recurrence was 20% in both groups.Conclusions.Articulating spacers offer functional advantages over static ones, particularly in delayed reimplantation, by preserving mobility and improving interim quality of life. Keywords: cement spacer, articulating spacer, non-articulating spacer, periprosthetic joint infection.