Antibiotic Cement-Coated interlocking Intramedullary Nails in the Treatment of Septic Complex Lower Extremity Reconstruction; A Retrospective Analysis with Two year Minimum Follow up

Abstract

Abstract. Background: To report on our experience with antibiotic cement coated interlocking intramedullary nails (ACC-IMNs) for limb salvage in septic complex lower extremity reconstruction with a minimum of 2-year follow up.Methods: We retrospectively reviewed the records of all consecutive patients who underwent a limb salvage procedure with ACC-IMNs. We reviewed patients' demographics, the preoperative infecting organism, and host type, time to bone union, complications, limb salvage rates, and infection control rates.Results: There were 28 patients with a mean age of 62 years (range 22-88). The mean follow up period was 40 months (range 28-84). The ACC-IMNs were used in 14 patients (50 %) to achieve knee fusion after failed revisions of infected total knee arthroplasty, in 8 patients (28%) for septic tibial nonunion, and in 6 patients (21%) with ankle fusion nonunions. Bony union/fusion was achieved in 87 % (21/24) of patients. The infection was controlled in 80% (21/26) of patients. Four out the five patients who had recurrent infection were type B hosts (p=0.63). The limb salvage rate was 89% (25/28). The overall complication rate was 32%.Conclusions: The use of ACC-IMNs was an effective treatment strategy and associated with high limb salvage and bone union rates. Furthermore, the infection recurrence rate was low. Knee fusion patients after failed TKA should be counseled preoperatively for a potential high complication rate.

Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

“…Makhdom et al. 2020 [ 22 ] Case series 28 patients 10-mm-diameter IM nail (not further specified) Infected TKA, infected tibial nonunions, ankle fusion nonunions Simplex cement (Stryker, Kalamazoo, MI) 2 g vancomycin and 2.4 g tobramycin per 40 g cement and additional 1 g tobramycin Circumferentially Not mentioned Silicone tubing with 12.7 mm internal diameter 80% (21/26) 87% (21/24) 24. Conway et al.…”

“…Treatment with antibiotic-containing cement- or bone graft substitute-coated orthopedic implants was not only performed as the initial revision procedure to aid in eradication of infection with simultaneous limited construct stability later needing further revision surgery for definitive fixation [ 10 – 14 , 21 , 23 , 29 – 38 ] ( n = 17), but also as the main definitive revision procedure with either no further planned procedures [ 8 , 9 , 15 , 17 , 19 , 20 , 22 , 24 – 26 , 28 , 39 – 45 ] ( n = 18) or additional surgery solely to remove the coated implants after completed healing and controlled infection [ 16 , 46 , 47 ] ( n = 3). Some studies ( n = 2) also implemented antibiotic-containing cement-coated implants as part of a three-stage revision procedure protocol [ 18 , 48 ].…”

Custom-Made Antibiotic Cement-Coated Nail for the Treatment of Infected Bone Defect

“…Bhatia et al reported a 95% rate of infection eradication [37]. Similar results proved that the bone cement nail has a satisfactory infection control effect [38].…”

Efficacy of Infection Eradication in Antibiotic Cement-Coated Intramedullary Nails for Fracture-Related Infections, Nonunions, and Fusions

“…First described in 2007, ACCINs offer the advantages of providing both antibiotic delivery and bone stability [ 1 ]. The literature shows multiple studies involving ACCINs that have demonstrated their successful implementation to treat infected nonunions and arthrodeses [ 2 , 3 , 4 , 5 , 6 ]. The 2018 International Consensus Meeting on Musculoskeletal Infection agreed that antibiotic-coated intramedullary nails were an effective treatment for these difficult cases [ 7 ].…”