Incidence of Deep Infection in Aseptic Revision THA using Vancomycin-Impregnated Impacted Bone Allograft

Abstract

The addition of antibiotic to cement is a frequent practice in aseptic revision hip surgery There is concern about adding vancomycin to cement due to potential effects on mechanical properties and prolonged elution of subtherapeutic levels antibiotic. Bone allografts can store and provide high levels of vancomycin to surrounding tissues. We analyzed the incidence of infection after one-stage aseptic revision hip reconstruction utilizing acetabular and/or femoral vancomycin-impregnated impacted bone allograft and a THA fixed with cement containing no antibiotic. We hypothesized that the infection rate may be similar to that reported in the literature following traditional impaction grafting using antibiotic loaded cement. Seventy five consecutive patients (80 hips) with a preoperative Merle D'Aubigné and Postel functional score averaging 4.8 points were followed up for a mean of 36 months (range 24 - 59 months). The incidence of infection was 1.25% (CI 95%=96.26-100%). A deep infection (thought to be haematognous in origin) occurred in 1 patient 2 years after the index surgery. The average postoperative Merle D´Aubigne score was 16.2 points. The last radiographic evaluation demonstrated a less than 5 mm acetabular migration and a less than 5 mm femoral subsidence in all cases. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of infection. This incidence of deep sepsis is similar to that reported with antibiotic-loaded PMMA but without the reported mechanical and pharmacological disadvantages.

Topically Applied Vancomycin Powder Reduces the Rate of Surgical Site Infection in Diabetic Patients Undergoing Foot and Ankle Surgery

“…14 Vancomycin powder has been used in bone cement for revision joint arthroplasty, and its use has been described in the spine and total joint surgery literature. 3 Chiang et al 5 reviewed 10 studies and concluded that local vancomycin powder was protective against superficial and deep SSIs in spine surgery, although the authors felt that publication bias may have been present. 5 In a separate meta-analysis, Kanj et al 17 reported similar results and recommended the use of topical vancomycin in clean orthopedic surgery.…”

“…Vancomycin-impregnated cement has been used in revision total joint arthroplasty as a method to reduce prosthetic infections. 3 Topically applied vancomycin has gained popularity in spine surgery and has been the subject of case series, meta-analysis, and systemic reviews. 1,5,8,17 The aim of this study was to evaluate the efficacy of topically applied vancomycin powder in reducing the rate of SSI in patients with DM undergoing foot and ankle surgery and to compare this study group with a cohort of diabetic patients who did not receive topically applied vancomycin.…”

Intraoperative culture positive allograft bone and subsequent postoperative infections: a retrospective review

“…1 Although the use of autograft bone remains the gold standard, 20 allograft bone is advantageous for several reasons, including unlimited and rapid supply as well as decreased donor site morbidity. 7,20 Several studies have examined complications of allograft bone, including infec tion, both for the donor 13,[21][22][23] and recipient. 1,2,4,6,7,9,12,15,20,24,25 Several studies examining the link between allograft bone and postoperative infection have cited various results, some attributing postoperative infection to allograft bone 2,6 and others to infection rates inherent with these often more complex procedures.…”

“…The average positive intraoperative allograft bone culture rate reported in the literature ranges from 1.4% to 12%. 4,7,9,[11][12][13] Although some studies comment that cases of positive cul ture taken at the time of implantation went on to develop wound infections, 2,6 most studies suggest that these posi tive cultures do not correlate with postoperative infections and that the organisms isolated in the postoperative infec tion are only rarely the same as those isolated in the intra operative allograft culture. 9,10,12,14,15 It is difficult to apply these results to all populations, as national policies for handling allograft bone differ.…”

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Six)

“…In 75 consecutive patients (80 hips), followed for a mean of 36 months (range 24 -59 months), deep infection occurred in one patient for an incidence of infection of 1.25%, which occurred 2 years after the index procedure and was thought to be hematogenous in origin (27).…”