Heidenreich MJ, Tetreault MW, Lewallen DG, et al. - Given the challenges encountered in managing a simultaneous periprosthetic joint infection (PJI) of an ipsilateral hip and knee arthroplasty, a complication of total hip and knee arthroplasties, researchers sought to evaluate whether total femur antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement spacers can be used in the staged treatment of such limb-threatening PJIs. Treatment with a total femur antibiotic spacer was performed in 13 patients (mean age at the time of spacer placement: 65 years). Polymicrobial PJIs occurred in nine patients. All spacers included vancomycin (3.0g/40g PMMA) and gentamicin (3.6g/40g PMMA), while amphotericin (150mg/40g PMMA) was included, in addition, in 8 spacers. Overall findings suggest viability of total femur antibiotic spacers, however, these are technically demanding, limb-salvage options for complex PJIs involving the ipsilateral hip and knee. In this largest series to-date, no amputations were required and 75% of reimplanted patients remained infection-free. Potential tenets of success were radical debridement, antimicrobial diversity, prolonged spacer retention, and limiting recurrent soft-tissue violation.