Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty

Abstract

Bone allografts can store and release high levels of vancomycin. We present our results of a two-stage treatment for infected hip arthroplasty with acetabular and femoral impaction grafting using vancomycin-loaded allografts. We treated 29 patients (30 hips) by removal of the implants, meticulous debridement, parenteral antibiotic therapy and second-stage reconstruction using vancomycin-supplemented impacted bone allografts and a standard, cemented Charnley femoral component. The mean follow-up was 32.4 months (24 to 60). Infection control was obtained in 29 cases (re-infection rate of 3.3%; 95% confidence interval 0.08 to 17) without evidence of progressive radiolucent lines, demarcation or graft resorption. One patient had a further infection ten months after revision caused by a different pathogen. Associated post-operative complications were one traumatic periprosthetic fracture at 14 months, a single dislocation in two hips and four displacements of the greater trochanter. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of further infection.

Infection in total hip replacement: meta-analysis

“…The theoretical disadvantage is the risk of colonisation of avascular grafts. Early reports of allograft use have shown excellent results [5].…”

“…Buttaro et al [5] reported 30 cases who received vancomycin-supplemented impaction bone grafting. Antibiotics were not added to cement used in the revision prosthetics.…”

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

“…Other porous biodegradable materials for local antibiotic delivery, like collagen sponges [46], cancellous bone [47], [48,49] and bioceramics [50], were not specifically designed to protect implanted biomaterials and their use for infection prevention in trauma is currently limited. Biodegradable polymers and sol-gel coatings have also been investigated to provide a controlled antibiotic release on titanium [51,52] or hydroxyapatite implants [53].…”

Initial stability of circumferential meshes with impacted bone allografts for massive femoral defects

“…The impaction grafting technique has been reported with good results in revision hip surgery: this technique restores bone stock, and morcellised bone grafts can be used as carriers of antibiotics in cases of previous infections [3,4,7,8,20,23]. When segmental defects are present, the combination of morcellised grafts with metal meshes has been associated with a favourable outcome [8,12,22].…”