Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox

Sanz-Ruíz, Pablo; Matas-Diez, José Antonio; Sánchez-Somolinos, Mar; Villanueva‐Martínez, Manuel; Vaquero-Martín, Javier

doi:10.1016/j.arth.2016.11.012

Cited by 51 publications

(37 citation statements)

References 16 publications

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“…The application of the current spacer with other commercial antibiotic cements or surgeon-defined antibiotic formulations or dosages will have to be further validated for mechanical safety and biological efficacy concerns. In addition, the Palacos R + G (0.5 g gentamycin/40 g powder) is generally applied for prophylaxis use [ 44 ]. Due to limitations in availability, the Palacos R+G was utilized in the current study.…”

Section: Discussionmentioning

confidence: 99%

Polyethylene-Based Knee Spacer for Infection Control: Design Concept and Pre-Clinical In Vitro Validations

Chang

Lee

Liau³

et al. 2020

Polymers

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Antibiotic-loaded polymethyl methacrylate (PMMA) has been widely applied in the treatment of knee periprosthetic joint infections. However, problems with antibiotic-loaded PMMA-based spacers, such as structural fracture and implant dislocation, remain unresolved. A novel polyethylene-based spacer, designed with an ultra-congruent articulating surface and multiple fenestrations, was introduced in the current study. Validation tests for biomechanical safety, wear performance, and efficacy of antibiotic cement were reported. During cycle fatigue testing, no tibial spacer failures were observed, and less wear debris generation was reported compared to commercial PMMA-based spacers. The volumetric wear of the novel spacer was within the safety threshold for osteolysis-free volumetric wear. An effective infection control was demonstrated despite the application of lesser antibiotic cement in the 30-day antibiotic elution test. The tube dilution test confirmed adequate inhibitory capabilities against pathogens with the loaded antibiotic option utilized in the current study. The novel polyethylene-based knee spacer may offer sufficient biomechanical safety and serve as an adequate carrier of antibiotic-loaded cement for infection control. Further clinical trials shall be conducted for more comprehensive validation of the novel spacer for practical application.

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Section: Discussionmentioning

confidence: 99%

Polyethylene-Based Knee Spacer for Infection Control: Design Concept and Pre-Clinical In Vitro Validations

Chang

Lee

Liau³

et al. 2020

Polymers

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“…We have recently demonstrated that the implementation of routine use of the low-dose ALBC PALACOS R+G (Heraeus Medical GmbH, Wehrheim, Germany) for all cemented primary hip and knee procedures in our institution led to a reduction of PJI cases by 60–70% compared to non-ALBC. 47 It is important to note that the infection rate of uncemented prostheses in the same observation periods remained unchanged, thus suggesting that the drop in infection cases might be in fact related to the switch in bone cement.…”

Section: Perioperative Antibiotic Prophylaxis (Pap)mentioning

confidence: 93%

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

Sanz-Ruíz

Berberich

2020

ORR

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There is growing body of evidence that important patient-, procedure- and pathogen-related factors are linked to higher risks for prosthetic joint infections (PJI) following arthroplasty surgeries. The prior identification and optimization of such risk factors is considered paramount to minimize the incidence of these infections. Without any doubt, antibiotic prophylaxis remains one of the cornerstones among all preventive measures. However, the ideal antibiotic prophylaxis is still in debate and discussions have emerged, whether certain situations deserve adjustments or variations of the standard protocol taking into account antibiotic resistance surveillance data and patient risk factors for infections. This review aims to provide the reader with an overview of possible antibiotic prophylaxis strategies in response to these risks and discusses the clinical experiences so far obtained. We further present preliminary evidence that the use of a reinforced local antibiotic prophylaxis regimen with high-dose dual antibiotic-loaded bone cement may be an effective and easy-to-apply option in patients at high infection risks.

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“…Intraoperatively, the reduction of airborne microorganisms resulted in decreased prosthesis-related infections in total hip arthroplasty and spinal surgeries, especially when utilized at the time of incision. Similarly, the use of antibiotic-loaded bone cement decreased PJI 28 as did gram-negative antibiotic prophylaxis using gentamicin or aztreonam in patients undergoing total hip arthroplasty 29 . Instead of antibiotics, antimicrobial solutions, such as 0.19% vol/vol acetic acid, were shown to reduce the risk of reinfection when used in a 20-minute soak when treating PJI 30 .…”

Section: Shoulder and Elbowmentioning

confidence: 99%

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

Chen

Nana²,

Nelson³

et al. 2017

The Journal of Bone and Joint Surgery

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Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox

Cited by 51 publications

References 16 publications

Polyethylene-Based Knee Spacer for Infection Control: Design Concept and Pre-Clinical In Vitro Validations

Polyethylene-Based Knee Spacer for Infection Control: Design Concept and Pre-Clinical In Vitro Validations

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

What’s New in Musculoskeletal Infection: Update Across Orthopaedic Subspecialties

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