Treatment of proximal femur infections with antibiotic-loaded cement spacers

Abstract

In case of periprosthetic hip infections the implantation of antibiotic-loaded PMMA spacers is accepted for an adequate treatment option. Although their indication for the treatment of destructive, bacterial infections of the proximal femur would make sense, literature data are scarce. Hence, the aim of this study was to evaluate the efficacy of antibiotic-impregnated spacers in the treatment of proximal femur infections.In 10 consecutive patients (5 M/ 5 F, mean age 66 y.) with bacterial proximal femur infections, a femoral head/neck resection was prospectively performed with a subsequent implantation of an antibiotic-loaded spacer. The joint-specific outcome was evaluated by the Merle d´Aubigne and the Mayo hip score, the general outcome by SF-36. The time periods were divided into “infection situation”, “between stages” and meanly 1 year “after prosthesis implantation”.The spacers were meanly implanted over 90 [155-744] days. In all cases an infection eradication could be achieved. After infection eradication, a prosthesis implantation was performed in 8 cases. The general scores showed significant increases at each time period. With regard to the dimension “pain”, both scores demonstrated a significant increase between “infection situation” and “between stages”, but no significance between “between stages” and “after prosthesis implantation”.Spacers could be indicated in the treatment of proximal femur infections. Besides an infection eradication, a pain reduction is also possible.

Treatment for periprosthetic infection with two-stage revision arthroplasty with a gentamicin loaded spacer. The clinical outcomes.

“…Na le ży rów nież wspo mnieć o wy bo rze me to dy le cze nia. Ogól nie przy ję tym le cze niem jest dwu etapo wa en do pro te zo pla sty ka re wi zyj na z za sto so waniem spa ce ra lub in ne go "wy peł nia cza" sta wu, który w od po wied nio dłu gim cza sie wy dzie li miej sco wo du żą ilość an ty bio ty ku [1,6,7,10]. Jed no eta po wa rewi zja koń czą ca się usu nię ciem pro te zy bez po nowne go za bie gu jest za re zer wo wa na dla wy jąt ko wych sy tu acji.…”

“…Obec nie naj lep szym roz wią za niem dla cho rych z IOP wy da je się być dwu eta po wa re im plan ta cja sztuczne go sta wu [1,6,7]. Pierw szy za bieg ope ra cyj ny po le ga na usu nię ciu en do pro te zy, oczysz cze niu za ka żo nej ko ści i usu nię ciu oko ło pro te zo wych tka nek mar twych (de bride ment lo ży pro te zy).…”

“…At present, a two-stage revision arthroplasty seems to be the best solution for PPI patients [1,6,7]. In the first stage, implant removal and radical débridement of infected tissues is performed, cultures from periprosthetic tissues are obtained and an antibioticloaded spacer is inserted.…”

Novel Articulating Medullary-sparing Spacer for the Treatment of Infectious Hip Arthritis

“…Of 9 hips, 8 were successfully converted to THA after an average of 23 weeks. Kelm et al 13 reported the efficacy of antibiotic-loaded spacers in the treatment of proximal femur infections in 8 patients with bacterial proximal femur infections. The spacer was produced using a CAD (computer aided design)-planned and CNC (Computer numerical control)-milled 2-part mold of polyoxymethylene, but cement acetabulum was not performed in these cases.…”

Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap

“…11 In another report, TNP required a mean period of 9 days, ranging from 3 to 16 days, until the inflammatory parameters of C-reactive protein, erythrocyte sedimentation rate and, leucocyte blood count had normalized and wound secretion had markedly decreased. 12 In retrospect, the total duration of 4 weeks of TNP and irrigation as used in the current case could probably have been shortened.…”