A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone Cement

Abstract

Aim: The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections. Methods: We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics—gentamycin and clindamycin—was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0–115.0) months. Results: Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%. Survival for any reason was significantly different between the types of revision (p = 0.026, Log-Rank-test), with lower survival rates after more complex surgical procedures. The 5-year survival rate with regard to revision for any reason was 91.3% [88.2–94.4%] and with regard to revision for PJI 98.2% [98.7–99.9%], respectively. Conclusion: The use of the dual-antibiotic-impregnated bone cement Copal G+C results in a lower rate of periprosthetic infections after aseptic knee prosthesis replacement than that reported in published prosthesis revisions using only one antibiotic in the bone cement.

Daptomycin-Impregnated PMMA Cement against Vancomycin-Resistant Germs: Dosage, Handling, Elution, Mechanical Stability, and Effectiveness

“…In clinical practice, spacers for two-stage revision procedures are created by using industrially manufactured cement already containing vancomycin, or by manually admixing vancomycin with PMMA cement [6,18,19]. The use of the commercially available cement COPAL ® G+V is already established for the prevention of PJIs, especially against the most frequent PJI germs S. aureus and S. epidermidis [8,18], but does not cover VRSA, VISA, or VRSE. In general, it's recommended to use a fixation or spacer cement containing two complementary antibiotics to best cover the spectrum of PJI pathogens [12].…”

“…Poly(methyl methacrylate) (PMMA) bone cements loaded with one (i.e., single-antibioticloaded bone cement (SALBC)) or two antibiotics (i.e., dual-antibiotic-loaded bone cement (DALBC)) are used for the prevention or treatment of PJIs, e.g., for a spacer in the interim period of a two-stage exchange procedure [4][5][6][7]. DALBC supports reducing PJIs especially well compared to SALBC [8]. Commercially available antibiotic-loaded bone cements (ALBCs) mainly contain the antibiotics gentamicin or tobramycin (aminoglycosides), vancomycin (a glycopeptide), and clindamycin (a lincosamide) [9].…”