Reconstruction following periprosthetic joint infection: cemented or uncemented

Cemented and cementless reconstruction techniques have been widely adopted in primary and aseptic revision total joint arthroplasty (TJA). Many variables influence a surgeon's decision to adopt a particular fixation strategy, and there is no clear consensus on the optimal approach. The literature on periprosthetic joint infection (PJI) has clearly shown the importance of utilizing cement in the first stage of a two-stage exchange arthroplasty in the form of an antibiotic delivery device or temporary spacer. However, very little has been established regarding the importance of fixation method (cemented versus cementless) at the time of definitive replantation and whether this plays a role in the successful eradication of PJI. For the hip, cementless fixation at reimplantation is still the standard of care given modern modular, fluted tapered stems that have high success in the setting of severe bone defects. Hybrid fixation, or cemented femoral components used with uncemented acetabular components, can also be performed when treating PJI especially when performing one-stage exchange arthroplasty, since the antibiotic cement can be used as a delivery device. For knee reimplantation, components are either inserted fully cemented or in a hybrid fashion, where cement is applied to the articular and metaphyseal portions of the bone that is supported by long diaphyseal engaging stems. Cemented stems enable the stress imparted by bone loss to be distributed along the entire length of the construct and can also support reconstructions that may require higher levels of constraint. The objectives of this review are to discuss fixation strategies available to surgeons at the time of the second stage procedure, and to discuss their implications in the success or failure of infection management.