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:10.2106/00004623-200704000-00026

Cited by 205 publications

(82 citation statements)

References 62 publications

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“…The use of PMMA cements as antibiotic delivery devices is a widely used practice in orthopedics and has shown to be effective in the prevention and treatment of infection in both one-stage and two-stage revisions [37,38]. Moreover, many surgeons started adding antibiotics manually to the cements before polymerization during surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

New PMMA-based composites for preparing spacer devices in prosthetic infections

Giavaresi

Minelli

Sartori

et al. 2012

J Mater Sci: Mater Med

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Even though the systemic antibiotic therapy is usually applied after prosthetic infections surgical treatments, it is unable to reach the infection site in sufficient concentrations to eradicate bacteria. Delivering antibiotics locally with the use of custom made device (spacer or nail coating) might eradicate or reduce the infection and the risk of recolonization, providing a very high concentration of antibiotic. PMMA-based (Mendec Spine) composites with BaSO(4) were enriched with β-tricalcium phosphate (Porosectan-TCP) or only a slightly higher BaSO(4) concentration (Porosectan-BaSO(4)) to obtain higher porosity. The aim of the study was to evaluate: (i) drug absorption capability and drug release kinetics in vitro soaking them with a combined solution of gentamicin and vancomycin, (ii) their in vitro and in vivo biocompatibility, and finally, (iii) they were tested preliminarily in an experimental model of bone infection. The simultaneous presence of β-TCP and BaSO(4) resulted in the formation of a texture of interconnecting channels with different diameters, from a few microns to several hundred microns, which totally filled the material. The porosity, determined by microcomputed tomography, was significantly higher in both tested plain composites (Porosectan-TCP: +17.3%; Porosectan-BaSO(4): +7.5%) in comparison to control composite material (Mendec Spine). The kinetics of antibiotic release from composites was rapid and complete, producing high drug concentrations for a short period of time. Both composites showed a good level of biocompatibility. The osteomyelitic model confirmed that both composites, soaked in antibiotic solution, were able to cure bone infection. These composites could be useful for preparing devices for prosthetic joint infections treatment also allowing the use of antibiotics solution at required concentrations.

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Section: Discussionmentioning

confidence: 99%

New PMMA-based composites for preparing spacer devices in prosthetic infections

Giavaresi

Minelli

Sartori

et al. 2012

J Mater Sci: Mater Med

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“…Spätinfekte treten später als 4 Wochen nach der Infektion auf und erfordern immer den Implantatwechsel [8]. Dieser kann einzeitig oder zweizeitig erfolgen.…”

Section: Akute Postoperative Infektion (Frühin-fektionunclassified

Periprothetische Infektion

Perka

Haas

2011

Chirurg

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Periprosthetic infections represent the most feared complications in orthopedic surgery. Frequently, the substantial challenges result more from a delayed diagnosis and an inadequate therapy than from the infection itself. The guiding symptom is pain. The determination of C-reactive protein (CRP) and the blood sedimentation rate (BSR) is the basic screening test for infection while joint aspiration is commonly used to confirm the diagnosis. Infection treatment with implant preservation is only promising and justifiable in the early postoperative infection period. The current concept of infection treatment consists of a two-stage revision with 6-8 weeks implant-free interval and an accompanying antibiotic therapy. The one-stage revision is the patient-friendliest procedure but requires strict prerequisites which may not be given in a number of cases. The reported mean success rates range from 80-100% with the respective therapeutic procedures. However, there is no single evidenced-based therapeutic concept throughout the whole course of treatment but frequently a various number of individual modifications. Nevertheless, a clear strategy in treatment planning using objective criteria without subjective decisions and emotions is essential for the success of therapy. If the healing rate falls under 80% the applied concept must be reconsidered.

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“…There are several reports in the modern literature on the advantages of a two-stage procedure using an antibioticloaded dynamic hip spacer [1][2][3]. The use of a staged approach is probably safer with regard to infection [1] and a dynamic spacer oVers the patient improved quality of life during the period between procedures [3] since it maintains leg length and joint motion, and allows the patient to mobilize.…”

Section: Discussionmentioning

confidence: 99%

“…The use of a staged approach is probably safer with regard to infection [1] and a dynamic spacer oVers the patient improved quality of life during the period between procedures [3] since it maintains leg length and joint motion, and allows the patient to mobilize. Further, by maintaining soft tissue status, it facilitates the second stage, which is likely the primary advantage.…”

Section: Discussionmentioning

confidence: 99%

“…the most common approach for management of chronic periprosthetic joint infection (PJI) is a two-stage replacement. The success rate for this technique exceeds 90% when an antibiotic-impregnated cement spacer is used during the period between stages [1]. Such spacers provide direct local delivery of antibiotics while preserving the joint space and facilitating the second-stage reimplantation surgery [2].…”

Section: Introductionmentioning

confidence: 99%

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Temporary cement tectoplasty: a technique to improve prefabricated hip spacer stability in two-stage surgery for infected hip arthroplasty

Flores

Corona

Cortina

et al. 2012

Arch Orthop Trauma Surg

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This technical note describes an intraoperatively custom-made, antibiotic-loaded bone cement roof, used in conjunction with a prefabricated hip spacer to improve component stability, as part of the first stage of a two-stage procedure for an infected hip implant. This technique was successfully used in seven cases who presented with extensive superior and/or posterio-superior acetabular defect, which created a risk of spacer dislocation. With this technique we were able to avoid any further dislocation in these seven cases. We believe that the technique may reduce postoperative spacer dislocation in cases with extensive acetabular defects, while improving clinical outcomes.

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

Cited by 205 publications

References 62 publications

New PMMA-based composites for preparing spacer devices in prosthetic infections

New PMMA-based composites for preparing spacer devices in prosthetic infections

Periprothetische Infektion

Temporary cement tectoplasty: a technique to improve prefabricated hip spacer stability in two-stage surgery for infected hip arthroplasty

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