Static Antibiotic Spacers in Periprosthetic Knee Infection: Indications, Technique, and Outcomes

Periprosthetic joint infection after total knee arthroplasty remains difficult to treat, particularly when infection is accompanied by major bone loss, instability, or damaged soft tissues. Although articulating spacers are widely used during two-stage exchange, a static spacer may offer a safer solution when preserving motion would put the reconstruction at risk.In this narrative review, we discuss when a static antibiotic spacer is appropriate, how its mechanical design affects treatment, and what the available evidence tells us about infection control and function. Comparative studies generally report similar infection outcomes with static and articulating spacers, while articulating designs tend to preserve a greater range of motion. These comparisons require caution because static spacers are often selected for the most severely compromised knees.We also consider patients in whom a second-stage reimplantation is unlikely to be safe or achievable. For a carefully selected patient, retaining a stable static spacer may offer a practical salvage option, although long-term mechanical and infectious risks remain.Rather than viewing static spacers as an obsolete alternative, we suggest considering them as one part of an individualized strategy in which stability, soft-tissue protection, infection management, and the patient’s goals guide the choice.