Two-stage revision in periprosthetic joint infection of the hip using a new intraoperatively molded articulating spacer design

Cacciola, Giorgio; Giustra, Fortunato; Bosco, Francesco; Meo, Federico De; Bruschetta, Antongiulio; Cavaliere, Pietro

doi:10.1016/j.jcot.2023.102223

Cited by 3 publications

(2 citation statements)

References 39 publications

(64 reference statements)

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“…One contributing factor is the design of the spacer, where a more robust endoskeleton augments strength and helps prevent spacer fractures [26]. Cacciola et al [27] demonstrated that a modular articulating spacer with a robust endoskeleton yields satisfactory functional outcomes while minimizing the risk of mechanical complications. However, these studies fail to address whether ALBC spacers with enhanced endoskeletons provide sufficient antibiotic release and local concentration.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics Elution Depth in Bone Cement: Impact of Surface Area and Volume

Huang,

Lin,

Chang

et al. 2024

Preprint

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Antibiotic-loaded bone cement (ALBC) plays a pivotal role in infection prevention and treatment related to musculoskeletal surgery. The release efficacy of antibiotics from ALBC is closely tied to its surface area, yet little is known about the effective release depth. To investigate the relationship between surface area, volume, and antibiotic elution, spheric ALBC specimens with consistent outer diameters but different internal metal sphere diameters were prepared. Two vancomycin doses were utilized in ALBC specimens with an outer diameter of 35 mm: high (4 g) and low (1 g). Each dosage group included five specimens containing embedded metal spheres with diameters of 15, 25, 29, 32, or 33 mm. The resulting shell-like ALBC specimens had thicknesses of 10 mm, 5 mm, 3 mm, 1.5 mm, or 1 mm, respectively. The specimens were immersed in sterile phosphate buffer solution, and antibiotic elution was measured at designated sampling times (1, 3, 6, 10, 24, 48, 72, and 168 hours). Methylene blue was employed to visualize penetration depth. Vancomycin elution did not display statistically significant differences between high- and low-dose groups. In both groups, specimens with 1 mm thickness exhibited a higher vancomycin release efficiency (high-dose group: 18560±5474 μg, 6.7%; low-dose group: 2017±419 μg, 2.6%), decreasing sharply in thicker ALBC specimens. Methylene blue penetration depth showed no apparent difference between high-dose and low-dose groups. ALBC thickness does not significantly impact antibiotic elution, while surface area and antibiotic dose exert notable effects. These in vitro findings offer potential applications in clinical treatments for musculoskeletal infections.

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Section: Discussionmentioning

confidence: 99%

Antibiotics Elution Depth in Bone Cement: Impact of Surface Area and Volume

Huang,

Lin,

Chang

et al. 2024

Preprint

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“…Intraoperatively molded hip spacers provide numerous advantages in managing PJI during two-stage revision surgery. The customization of spacer size and shape improves joint stability [14]. These spacers enable the incorporation of appropriate antibiotics into the cement based on the results of antibiotic susceptibility tests.…”

mentioning

confidence: 99%

Is Gentamicin Elution Influenced by the Timing of Antibiotic Addition to the Bone Cement? An In Vitro Study on Articulating Hip Spacers

Cacciola,

Bosco,

Giustra

et al. 2023

Prosthesis

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Periprosthetic Joint Infection (PJI) is a challenging complication after joint replacements, and cement spacers are standard treatment in two-stage revision surgery. This experimental in vitro study aimed to evaluate the elution properties of different gentamicin formulations from commercially available intraoperative molded hip cement spacers. The study compared spacers prepared with premixed antibiotic bone cement, spacers with antibiotic powder added during preparation, spacers stored for two months, and spacers with an additional antibiotic. The results showed that the timing of antibiotic addition influenced gentamicin elution, with immediate elution resulting in higher levels than stored spacers. Spacers with antibiotic powder added during preparation exhibited higher elution than premixed antibiotic spacers. Furthermore, adding vancomycin to the bone cement significantly increased gentamicin elution. These findings suggest that optimizing the timing and method of antibiotic addition in cement spacers may enhance the effectiveness of antibiotic treatment in PJI. However, further research is needed to validate these findings and explore their clinical implications.

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