Palacos Gentamicin for the Treatment of Deep Periprosthetic Hip Infections

Garvin, Kevin L.; Evans, Brian G.; Salvati, Eduardo A.; Brause, Barry D.

doi:10.1097/00003086-199401000-00015

Cited by 113 publications

(58 citation statements)

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“…15 of the 16 hips healed, which compares favorably with one-stage results (84% cure, 8-10% relapse) (Raut et al 1994, Callaghan et al 1999 and is similar to outcomes published for the twostage strategy (85-95% eradication rate, 7-22% recurrence) (McDonald et al 1989, Colyer and Capello 1994, Garvin et al 1994, Lai et al 1996, Tsukayama et al 1996, Younger et al 1997, Haddad et al 1999, Hsieh et al 2004, Kraay et al 2005. The clinical and functional results in re-implanted patients were satisfactory, but the overall functional results were not so positive because of a high proportion of resection-arthroplasty.…”

Section: Discussionsupporting

confidence: 77%

Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years

et al. 2007

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Background and purpose Exchange surgery in late arthroplasty infection is directed against bacteria adhering to implants. Therapies based on antibiotics that are effective intracellularly have been proposed recently. We have combined both strategies to improve the cure rate.Methods 40 consecutive patients (16 hips, 24 knees) were diagnosed with late arthroplasty infection. The organisms isolated were 35 Staphylococcus, 19 of which were methicillin-resistant, 4 Enterococcus, 6 Gram-negative bacilli, and 4 Corynebacterium. The infections were managed by a combined therapy consisting of two-stage exchange surgery and two oral intracellularly-effective antibiotics. The antibiotics were selected according to bacterial sensitivity and intracellular and biofilm effectiveness. Second re-implantation surgery was delayed until clinical and analytical normalization. Patients were in hospital for only 1 week after each surgery, and were followed up prospectively on an outpatient basis (2-9 years). Cure of the infection was defined as absence of clinical, serological, and radiographic signs of infection during the whole follow-up.Results The infection was resolved in 38/40 patients (15/16 hips and 23/24 knees).Interpretation Oral antibiotics that are effective intracellularly in combination with two-stage exchange surgery is a promising alternative for treating late arthroplasty infections. Oral antibiotics shorten hospitalization and reduce patient discomfort.

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Section: Discussionsupporting

confidence: 77%

Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years

et al. 2007

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“…According to previous reports (Table 3), some surgeons routinely perform one-stage revision THAs, with infection control rates in six studies reported to be 77-100 % [1,2,12,22,23,25]. Others, including our study, selected one-stage revision THA depending on patient requirements and showed infection control rates of 76-100 % in the eight studies [13,[15][16][17][18][19]26]. These rates were similar to those reported in studies only performing onestage revision THAs.…”

Section: Discussionsupporting

confidence: 86%

Pre-operative scoring system to determine the surgical strategy for periprosthetic hip infection

Iida

Ueda

et al. 2014

International Orthopaedics (SICOT)

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Purpose The aim of this study was to evaluate the results of one-and two-stage revision total hip arthroplasties (THAs) and to determine a rational surgical treatment strategy for periprosthetic hip infections. Methods We constructed a 12-point preoperative scoring system to suggest either one-or two-stage revision THAs, based on a retrospective analysis of 55 operative procedures. Prosthesis survival was analysed using the Kaplan-Meier method, and the validity of the scoring system was evaluated using receiver-operating characteristic curves. Results At the end point of implant removal due to recurrent infection, the ten year survival rates were 94 and 87 % for oneand two-stage revision THAs, respectively. One-stage revision THA was recommended for patients scoring >9 points. The risk of recurrent infection in patients scoring 4 points was 83 %. The sensitivity and specificity of a cut-off value of 4 points, determined by the scoring system, were 83 and 100 %, respectively. Conclusions The novel pre-operative scoring system was useful for the management of periprosthetic hip infections.

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“…First, the zirconium and metal particles detected could have originated from the original, infected prostheses, especially because Keen et al [29] reported detection of zirconium particles in the synovial membrane after many years of endoprosthesis implantation. Although this cannot be totally excluded, we assumed most of the abraded material we detected came from the spacers because part of the treatment of a periprosthetic infection usually involves radical débridement and synovectomy before the spacer is implanted [11,14,15,19,24,33,35]. Analyses of synovial controls obtained at the time of prosthesis removal could have addressed this question but we had no such controls.…”

Section: Discussionmentioning

confidence: 99%

“…Survival rates between 90% and 100% are reported for infected hip arthroplasties [11,14,15,33], and between 91% and 96% for infected knee arthroplasties [18,24,35]. The function of the spacer is to release the antibiotic into the infected bed of the prosthesis, minimize soft tissue contractures, and maintain reasonable functionality until a prosthesis can be reimplanted [4].…”

Section: Introductionmentioning

confidence: 99%

Articulating Spacers Used in Two-stage Revision of Infected Hip and Knee Prostheses Abrade with Time

Fink

Rechtenbach

Büchner

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis. Questions/purposes We asked whether particulate material abraded from spacers could be detected in the synovial membrane 6 weeks after implantation when the spacers were removed for the second stage of the revision. Patients and Methods Sixteen hip spacers (cemented prosthesis stem articulating with a cement cup) and four knee spacers (customized mobile cement spacers) were explanted 6 weeks after implantation and the synovial membranes were removed at the same time. The membranes were examined by xray fluorescence spectroscopy, xray diffraction for the presence of abraded particles originating from the spacer material, and analyzed in a semiquantitative manner by inductively coupled plasma mass spectrometry. Histologic analyses also were performed.

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Palacos Gentamicin for the Treatment of Deep Periprosthetic Hip Infections

Cited by 113 publications

References 0 publications

Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years

Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2–9 years

Pre-operative scoring system to determine the surgical strategy for periprosthetic hip infection

Articulating Spacers Used in Two-stage Revision of Infected Hip and Knee Prostheses Abrade with Time

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