Economic advantage of 'self-made' antibiotic-loaded spacer compared to prefabricated antibiotic-loaded spacer and spacer molds in two-staged revision arthroplasty

Infection after total hip or total knee arthroplasty is a serious complication implying great costs for the health care system. Amongst the different treatment options, the two-step exchange using a spacer in the interval is a valid option. We evaluate the economic impact of our self-made antibiotic-loaded hip and knee cement spacers compared with prefabricated spacers and spacer molds. Costs to prepare self-made cement spacers are detailed for each spacer type. We also assess the intraoperative time spent for fabricating our self-made hip and knee spacers. The price of these self-made knee spacer is 514 CHF (450 EUR / 505 USD) if non-articulated and 535 CHF (470 EUR / 525 USD) if articulated; the price for the self-made hip spacer is 749 CHF (760 EUR / 735 USD). Our average preparation time is 14 minutes for our self-made knee spacers and 16 minutes for our self-made hip spacers. While the senior surgeon is fabricating the self-spacers, another surgeon of the team continues intensive irrigation and debridement. Thus, no time is lost waiting for the self-spacer to be fabricated. In our hands, self-made hip and knee spacers are at least 40-50% cheaper than prefabricated spacers and spacer-molds. This is a serious economic advantage in this already expensive surgery. When done in teamwork, self-spacer fabrication does not increase the surgery time. The economic advantage is added to the main and most important advantage of selfmade spacers, which remains the possibility of patient adapted anatomical reconstruction of the joint.