Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty

Çağlar, Ömür; Tokgözoğlu, Mazhar; Akgün, Rahmi Can; Atilla, Bülent

doi:10.5606/ehc.2020.76108

Cited by 9 publications

(9 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vancomycin and amphotericin B were the agents mostly used (60.5% and 51.2%, respectively), followed by gentamycin (51.2%). Cement spacers with antimicrobial agents are recommended in cases of TSRA due to PJI [ 76 , 77 ]. The release of antibiotics from bone cement usually follows a biphasic pattern, with high early release in the first 24 h from the surface of the spacer, then followed by gradual release over the following days.…”

Section: Discussionmentioning

confidence: 99%

“…The release of antibiotics from bone cement usually follows a biphasic pattern, with high early release in the first 24 h from the surface of the spacer, then followed by gradual release over the following days. The elution of the antibiotics from bone cement in high concentrations is an important step in healing [ 76 , 77 ]. Based on in vitro studies, only fluconazole, voriconazole and amphotericin B have been evaluated and, thus, may be used for impregnation of bone cement.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fungal Periprosthetic Hip Joint Infections

et al. 2022

View full text Add to dashboard Cite

Introduction: Fungal hip prosthetic joint infections (PJIs) are rare but severe infections. Their incidence has increased in the last decades due to the aging population, as well as due to the increased number of immunosuppressed hosts. The present review of all published fungal PJIs in hip arthroplasties aims to present as much data as possible for both medical and surgical treatment options, so that the best applicable management may be concluded. Methods: A meticulous review of all published fungal hip PJIs was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 89 patients suffering fungal hip PJI were identified. The patients’ mean age was 66.9 years. The mean time from initial arthroplasty to onset of symptoms was 69.3 months, while 40.4% of the patients were immunocompromised. The most common imaging method indicating diagnosis was plain X-ray or CT scan (20.2%), while definite diagnosis had become possible through cultures in most cases (98.9%), and/or histology (44.9%). The most frequently isolated fungus was C. albicans (49.4%), followed by C. parapsilosis (18%) and C. glabrata (12.4%), while bacterial co-infection was present in 32 cases (36%). Two-stage revision arthroplasty (TSRA) was the most commonly performed procedure (52.8%), with mean time between the two stages = 7.9 months. Regarding antifungal treatment (AFT), fluconazole was the preferred agent (62.9%), followed by amphotericin B (36%), while the mean duration of AFT was 5.1 months. Outcome was successful in 68 cases (76.4%). Conclusions: Both diagnosis and management of fungal PJIs in patients having undergone total hip arthroplasty are quite demanding. A multidisciplinary approach is of utmost importance, since the combination of AFT and TSRA appears to be the proper treatment method.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fungal Periprosthetic Hip Joint Infections

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Among cirrhotic patients of total hip arthroplasty, higher rates of infection are reported for hip fractures (3.7%) than for non-hip fracture diagnosis (0.7%). [45][46][47][48][49] In conclusion, the current review identifies multiple significant musculoskeletal complications related to CLD. The three most common complications associated with CLD are HO, infections (septic arthritis, spondylodiscitis, prosthetic joint infection), and sarcopenia.…”

Section: Periprosthetic Complicationsmentioning

confidence: 98%

Common musculoskeletal disorders in chronic liver disease patients

et al. 2021

View full text Add to dashboard Cite

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

show abstract

“…In addition to the economic burden, it may cause implant failure and multiple operations. [ 1 ] The systemic treatment of infected implant with antibiotics is often poor, as the access of antibiotics to the infection site is inadequate. Adhesion of bacteria to the implant surface and biofilm formation are very critical stages in the progression of the infection.…”

Section: Introductionmentioning

confidence: 99%

Silver ion doped hydroxyapatite-coated titanium pins prevent bacterial colonization

2021

View full text Add to dashboard Cite

Objectives This study aims to evaluate the effectiveness of silver ion doped calcium phosphate-based ceramic nano powder-coated titanium pins in preventing bacterial colonization. Materials and methods A total of 66 titanium pins were divided into three groups of 22 implants. The first group was coated with silver ion doped calcium phosphate-based ceramic powder by using electrospray method. The second group was coated with pure hydroxyapatite (HA), and the remaining pins were used without any coating. The remaining 22 pins were used without any coating. Staphylococcus epidermidis clinical isolate was used for the study. Each pin was placed in 1¥104 CFU/mL bacterial suspension containing tube and at 24 h quantitative culture of bacteria on the broth and on the pins were performed. Free silver ions were determined by atomic absorption method. The antibacterial culture tests were repeated on Day 2 and Weeks 2, 4, 6, and 8. Results Bacterial growth was statistically higher in broth containing uncoated pins, compared to broth media containing silver ion doped HA-coated, and pure HA-coated pins at 24 h (p=0.036 and p=0.009, respectively). The release of bacteria from silver doped HA-coated pins was statistically less, compared to pure HA-coated pins and uncoated pins (p=0.039 and p=0.002, respectively). No significant differences were observed between the HA-coated and uncoated pin groups. Minimum inhibitory concentration levels for silver ion doped powder was 8 μg/mL for coagulase-negative Staphylococcus. No free silver ions were detected in the broth media. Conclusion Silver ion doped nano size calcium phosphate-based powder-coated titanium pins reduced the bacterial colonization significantly. Using silver ion doped materials in the body can be a good option to prevent from implant related infections.

show abstract

Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty

Cited by 9 publications

References 32 publications

Fungal Periprosthetic Hip Joint Infections

Fungal Periprosthetic Hip Joint Infections

Common musculoskeletal disorders in chronic liver disease patients

Silver ion doped hydroxyapatite-coated titanium pins prevent bacterial colonization

Contact Info

Product

Resources

About