Two-Stage Revision Hip Arthroplasty for Infection with a Custom-Made, Antibiotic-Loaded, Cement Prosthesis as an Interim Spacer

Hsieh, Pang‐Hsin; Chen, Lih Huei; Chen, Chi Hwa; Lee, Mel S.; Yang, Wen E.; Shih, Chun–Hsiung

doi:10.1097/01.ta.0000130757.53559.bf

Cited by 93 publications

(89 citation statements)

References 38 publications

(35 reference statements)

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“…Moreover, the local levels of antibiotic released by the spacer likely would influence the detection of viable bacteria [9]. For these reasons, we decided to forgo the second aspiration and rather to make a decision based on clinical findings and the CRP as described by Hsieh et al [36]. The high rate of success regarding eradication of infection suggests our approach was appropriate.…”

Section: Discussionmentioning

confidence: 99%

Two-stage Cementless Revision of Infected Hip Endoprostheses

Fink

Grossmann

Fuerst

et al. 2009

Clinical Orthopaedics &Amp; Related Research

112

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Cementless two-stage revision of infected total hip prostheses lacks the possibility of local antibiotic protection of the implant at the time of reimplantation, which leads to the concern that this protocol may not sufficiently eradicate periprosthetic infection. Moreover, early implant loosening as much as 18% and stem subsidence as much as 30% have been reported. To determine whether a cementless revision could eradicate infection and achieve sufficient implant stability, we prospectively followed 36 patients with two-stage revisions for septic hip prostheses. We used a uniform protocol of a 6-week spacer interval, specific local and systemic antibiotic therapies, and cementless modular revision stems. The minimum followup was 24 months (mean, 35 months; range, 24-60 months). In one patient, the spacer was changed when the C-reactive protein value failed to normalize after 6 weeks, and the reimplantation was performed after an additional 6 weeks. No infections recurred. There was no implant loosening and a 94% bone-ingrowth fixation of stems. Subsidence occurred in two patients. The Harris hip score increased from a preoperative mean of 41 to 90 at 12 months after reimplantation and later. Using cementless prostheses in two-stage revisions of periprosthetic infections of the hip in combination with a specific local and systemic antibiotic therapy seems to eradicate infection and provide implant stability.

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Section: Discussionmentioning

confidence: 99%

Two-stage Cementless Revision of Infected Hip Endoprostheses

Fink

Grossmann

Fuerst

et al. 2009

Clinical Orthopaedics &Amp; Related Research

112

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“…We have found in our previous study that 8 g of antibiotic powder with a package of 40 g of cement polymer (Surgical Simplex, Limerick, Ireland) is the highest mixture ratio allowing bone cement to be introduced into the mold and formed into a spacer without difficulty. 7 The average amount of cement utilized in each spacer was 86.7 g AE 10.3 g (mean AE SD), corresponding to 17.3 g AE 2.1 g (mean AE SD) antibiotics.…”

Section: Pmma Spacer Prosthesismentioning

confidence: 99%

“…7 In brief, we used custom-made metal molds with several stainless wires as an endoskeleton to form the femoral components. The acetabular component was made from a bolus of antibiotic-cement inserted into the acetabular cavity and then shaped into hemispherical with use of a retrieved unipolar cup.…”

Section: Pmma Spacer Prosthesismentioning

confidence: 99%

“…The application of articulating polymethylmethacrylate (PMMA) spacers to manage the patients between stages has recently become a common approach. 6,7 When impregnated with antibiotics, these spacers not only serve as a temporary hip prosthesis to retain soft tissue tension, maintain joint function, and facilitate subsequent reimplantation, 8,9 but can also be utilized as a potential local drug delivery system to provide high antibiotic levels at the infection site. 10 The use of antibiotic-impregnated PMMA bone cement to treat musculoskeletal infections has been reported in literature for decades.…”

Section: Introductionmentioning

confidence: 99%

“…12,16 The purpose of this study was to investigate the in vivo elution of antibiotics from an articulated PMMA hip spacer previously found useful. 7 A large amount of vancomycin and aztreonam, antibiotics that are active against most common orthopedic pathogens, were used in these spacers. Antibiotic concentrations at the site of infection were measured by high performance liquid chromatography (HPLC) during the initial period as well as several months following spacer implantation.…”

Section: Introductionmentioning

confidence: 99%

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High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex™ cement spacers in two‐stage revision of infected hip implants: A study of 46 patients at an average follow‐up of 107 days

Hsieh

Chang

Chen

et al. 2006

Journal Orthopaedic Research

Self Cite

117

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This study investigated the release of antibiotics in vivo, from an articulating polymethylmethacrylate (PMMA) spacer used in two-stage revision arthroplasty of infected hip implants. Forty-six patients who underwent two-stage revision hip arthroplasty for infections were managed with an interim PMMA spacer loaded with a high dose of vancomycin and aztreonam. Serum and aliquots of drainage collected after the first-stage surgery, and joint fluid obtained at the time of the second-stage surgery were analyzed for antibiotic concentrations by high performance liquid chromatography and bioactivity by tube dilution bioassay. Following implantation, the highest levels of antibiotics were measured in aliquots of drainage on the first day (vancomycin: 1538.0 AE 243.6 mg/mL; aztreonam: 1003.5 AE 323.5 mg/mL), decreasing to 571.9 AE 169.4 mg/mL for vancomycin and 313.6 AE 88.3 mg/mL for aztreonam after 7 days. Antibiotic concentrations in serum were very low (vancomycin: 0.58 AE 0.2 mg/mL, range: 0.1-1.6 mg/mL; aztreonam: 0.46 AE 0.3 mg/mL, range: 0.1-0.9 mg/mL at 24 h) and there was no systemic adverse effect. At a mean 107 days after the first-stage surgery, the concentrations of antibiotics in joint fluid were well above the minimal inhibitory concentration of most common microorganisms. The released antibiotics were bioactive against the test organisms. Based on the observed results, we confirmed the safety and effectiveness of in vivo drug delivery from antibiotic-impregnated PMMA hip spacers. ß

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Spacers

2014

Journal Orthopaedic Research

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Two-Stage Revision Hip Arthroplasty for Infection with a Custom-Made, Antibiotic-Loaded, Cement Prosthesis as an Interim Spacer

Abstract: We have found that our two-stage treatment protocol is a reliable approach for the management of infected hip prostheses. It is effective for eradicating infection and for providing a mobile and functional joint through the treatment course.

Cited by 93 publications

References 38 publications

Two-stage Cementless Revision of Infected Hip Endoprostheses

Two-stage Cementless Revision of Infected Hip Endoprostheses

High concentration and bioactivity of vancomycin and aztreonam eluted from Simplex™ cement spacers in two‐stage revision of infected hip implants: A study of 46 patients at an average follow‐up of 107 days

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