Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty

Cui, Quanjun; Mihalko, William M.; Shields, John S.; Ries, Michael D.; Saleh, Khaled J.

doi:10.2106/jbjs.e.01070

Cited by 255 publications

(212 citation statements)

References 88 publications

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“…Antibiotic concentration has also been controversial. While selection has been limited to thermostable antibiotics due to the exothermic nature of polymethylmethacrylate (PMMA) formation, the effective concentration for control of infection has yet to be determined [3]. Control of infection may relate to the design of the spacer (eg, choice and concentration of antibiotics).…”

Section: Discussionmentioning

confidence: 99%

“…In the knee, partial load-bearing articulating spacers have allowed easier reimplantation during the second stage, and decreased bone loss between stages [7]. Conversely, interpositional spacers have offered higher local delivery of antibiotics, but were associated with soft tissue contractures, limited range of motion, and increased bone loss [3,7,8]. In the hip, partial load-bearing spacers have been associated with an alternate set of complications, as they had higher rates of dislocation and fracture of the spacer itself [8].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical options have included component retention with local irrigation and debridement with or without polyethylene liner exchange, one-or two-stage revisions, or resection arthroplasty [19,21]. For chronic, delayed infections, most surgeons in North American have considered a two-stage revision the gold standard [3,20], often utilizing a spacer of either partial load-bearing design [8] or an interpositional, nonload-bearing design [5,7,8,20] between stages with concurrent parenteral antibiotic therapy. Partial loadbearing spacers have offered the benefits of preserving bone stock, maintaining the soft tissue envelope, and potentially improving functionality between stages [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Degen

Davey

Howard

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Introduction Treating deep infection following THA has been a challenge. While the standard treatment has remained a two-stage revision, spacer designs, incorporated antibiotics, and concentrations have varied. Since control of infection may relate to choice and concentration of antibiotics, it is important to report rates of control from various spacers. Questions/purposes We therefore determined (1) the rate of infection control and (2) complications associated with a prefabricated, load-bearing, gentamicinimpregnated hip spacer in treating periprosthetic infections of the hip. Methods We retrospectively reviewed 33 patients with periprosthetic THA infections treated with a prefabricated, partial load-bearing, gentamicin-impregnated hemiarthroplasty spacer. Thirty of the 33 patients underwent second stage reimplantation after a mean 15 weeks. We collected patient demographic data, laboratory values, infecting organism, size of spacer mold, antibiotic selection, complications, and infection control rates from two academic centers. Recurrent infection at last followup was determined by the presence of physical symptoms or signs or elevated serologic tests. The minimum followup was 24 months (mean, 43 months; range, 24-70 months).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Degen

Davey

Howard

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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“…An intra-articular PJI model was created by implanting osteochondral plugs of VPE, non-antibiotic containing UHMWPE, and a commonly used bone cement spacer formulation [35] (contains 8.3 wt% tobramycin sulfate and 2.3 wt% vancomycin HCl, VTBC ) in the femoral trochlear groove and a titanium (Ti) plug with a porous surface in the tibial plateau of skeletally mature New Zealand white rabbits. All rabbits received two bacterial suspensions (5×10 7 CFU/ml each) that were injected in the distal tibial canal as well as the intra-articular space (Figure 4a, 4b).…”

Section: Vpe Eradicated Planktonic S Aureus In Pji Modelmentioning

confidence: 99%

A fully functional drug-eluting joint implant

et al. 2017

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Despite advances in orthopedic materials, the development of drug-eluting bone and joint implants that can sustain the delivery of the drug and maintain the necessary mechanical strength in order to withstand loading has remained elusive. Here, we demonstrate that modifying the eccentricity of drug clusters and the percolation threshold in ultrahigh molecular weight polyethylene (UHMWPE) results in maximized drug elution and in the retention of mechanical strength. The optimized UHMWPE eluted antibiotic at a higher concentration for longer than the clinical gold standard antibiotic-eluting bone cement while retaining the mechanical and wear properties of clinically used UHMWPE joint prostheses. Treatment of lapine knees infected with Staphylococcus aureus with the antibiotic-eluting UHMWPE led to complete bacterial eradication and to the absence of detectable systemic effects. We argue that the antibiotic-eluting UHMWPE joint implant is a promising candidate for clinical trials.

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“…Bertazzoni Minelli et al [3] reported a high level of release of gentamicin and vancomycin soon after implantation followed by lower but constant levels at 3 and 6 months after surgery. Different antibiotics are released at different rates from the spacers and affect each other when in combination with other antibiotics [5]. Thus, one cannot make assumptions about one antibiotic based on evidence from another.…”

Section: Introductionmentioning

confidence: 99%

Sufficient Release of Antibiotic by a Spacer 6 Weeks after Implantation in Two-stage Revision of Infected Hip Prostheses

Fink

Vogt

Reinsch

et al. 2011

Clinical Orthopaedics &Amp; Related Research

105

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Background Although antibiotic-loaded spacers are commonly used to treat periprosthetic infections, it is unclear whether spacers continue to release bactericidal levels of antibiotic 6 weeks after implantation. Questions/purposes We asked whether an antibiotic can be detected in the tissue surrounding the spacer 6 weeks after implantation and whether the concentration is higher than the minimal inhibition concentration (MIC) previously determined for pathogens that are responsible for most periprosthetic infections. Methods We removed 14 spacers used in two-stage septic revisions of infected hip prostheses 6 weeks after the primary implantations and determined the concentration of the antibiotics in the membrane formed between the spacer and the neighboring bone on the acetabular and the femoral sides. In seven cases Copal cement with gentamicin and clindamycin were used, and in seven other cases vancomycin was added to the Copal cement. Concentrations of the spacer antibiotics in the neighboring tissue were determined by tandem mass spectroscopy. Results All three antibiotics were detected in concentrations higher than their MIC. There were no differences between the groups regardless whether vancomycin was added to the cement, or whether the cement was applied with the acetabular cup spacer or with the stem spacer. Conclusions We concluded that, using the spacer technique described in this study, 6 weeks after spacer implantation, the concentrations of antibiotic are sufficient to treat a periprosthetic infection.

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Antibiotic-Impregnated Cement Spacers for the Treatment of Infection Associated with Total Hip or Knee Arthroplasty

Cited by 255 publications

References 88 publications

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

Does a Prefabricated Gentamicin-impregnated, Load-bearing Spacer Control Periprosthetic Hip Infection?

A fully functional drug-eluting joint implant

Sufficient Release of Antibiotic by a Spacer 6 Weeks after Implantation in Two-stage Revision of Infected Hip Prostheses

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