Antibiotics release from cement spacers used for two‐stage treatment of implant‐associated infections after total joint arthroplasty

Abstract

Two‐stage revision arthroplasty is the treatment of choice for periprosthetic infection, a serious complication after knee or hip arthroplasty. Our prospective clinical trial aimed to investigate the concentrations of gentamicin and vancomycin in wound exudate and tissue in two‐stage revision arthroplasty. Wound exudate and periprosthetic membrane samples were collected from 18 patients (10 hip and eight knee patients), who were due for two‐stage treatment after a periprosthetic joint infection. Samples were taken during insertion of antibiotic‐impregnated spacers and after their removal. The concentrations of gentamicin and vancomycin in wound exudates and adjacent tissue were analyzed using high‐performance liquid chromatography mass spectrometry. Average time period of spacer implantation was 13.6 weeks (9.3–22.6 weeks). The concentration of vancomycin in wound exudate decreased from a median of 43.28 μg/mL (0.28–261.22) after implantation to 0.46 μg/mL (0.13–37.47) after the removal of the spacer. In the adjacent tissue, vancomycin concentration was mainly undetectable prior to spacer implantation (0.003 μg/g [0.003–0.261]) and increased to 0.318 μg/g [0.024–484.16] at the time of spacer removal. This was also observed for gentamicin in the tissue of patients who previously had cement‐free implants (0.008 μg/g [0.008–0.087] vs. 0.164 μg/g [0.048–71.75]) while in the tissue of patients with previously cemented prosthesis, baseline concentration was already high (8.451 μg/g [0.152–42.926]). Despite the rapid decrease in antibiotics release from spacer cement observed in vitro , in vivo antibiotics are much longer detectable, especially in the adjacent soft tissue. © 2018 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published By Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1587–1597, 2019.

Comparing the Efficacy of Articulating Spacers in Two-Stage Revision for Periprosthetic Joint Infection Following Total Knee Arthroplasty: All-Cement Spacers vs Sterilized Replanted Metal-Polyethylene Spacers

“…Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) has been one of the most serious and challenging complications. 1 Dale et al 2 reported that the incidence of PJI following TKA ranged from 0.5% to 2.0%. With the population aging, the incidence of TKA is growing rapidly and as a result, the number of PJI cases is also increasing.…”

Total hip revision with custom-made spacer and prosthesis: A case report

“…In our experience, the advantages of custom-made spacers included retention of limb length and lateral offset, both of which made it easier to perform further revisional surgery[ 8 ]. Moreover, custom-made spacers also allow the treating surgeon to control the type and dosage of antibiotics[ 9 ].…”

Intra-articular versus systemic vancomycin for the treatment of periprosthetic joint infection after debridement and spacer implantation in a rat model

“…Up to 28% of the patients require repeated debridement due to infection recrudescence caused by MRSA. 14 Although up to 4 g of vancomycin can be added to 40 g cement powder when generating an antibiotic spacer, according to some clinical reports 15 , 16 and reviews, 17 , 18 less than 5% of the total vancomycin has been shown to be released from cement spacer, 19 , 20 and an effective vancomycin concentration was only detected during the first few days after spacer implantation. 21 , 22 Thus, the traditional approach of combining systemic vancomycin with an ALCS does not appear to be an optimal approach for achieving MBECs, due to the limited spacer antibiotic loading and release.…”