Despite significant advances in intraoperative antimicrobial procedures, deep wound infection remains the most serious complication associated with primary, cemented total joint arthroplasty. A systematic review was conducted to evaluate studies of antibiotic bone cement prophylaxis for reducing the risk of deep wound infection. The literature included 22 articles providing estimates of the prophylactic effectiveness of antibiotic cement. In reducing deep wound infection, antibiotic cement was consistently superior to plain cement, similar to systematic antiobiotics, and independent and additive in effect when combined with other prophylactic measures. Randomized controlled trials in particular had important methodological limitations. However, the collective results nearly unanimously favored prophylactic use of antibiotic cement in primary arthoplasty procedures.
"Based on our study, we have reason to believe that there is now a trend towards higher susceptibility to deep infection for uncemented THAs than for THAs implanted with cement-containing antibiotics. This confirms earlier findings that antibiotic-loaded bone cement protects against infection (Engesaeter et al. 2003, Block and Stubbs 2005, Parvizi et al. 2008b). "
[Show abstract][Hide abstract] ABSTRACT: Over the decades, improvements in surgery and perioperative routines have reduced the incidence of deep infections after total hip arthroplasty (THA). There is, however, some evidence to suggest that the incidence of infection is increasing again. We assessed the risk of revision due to deep infection for primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 1987-2007.
We included all primary cemented and uncemented THAs reported to the NAR from September 15, 1987 to January 1, 2008 and performed adjusted Cox regression analyses with the first revision due to deep infection as endpoint. Changes in revision rate as a function of the year of operation were investigated.
Of the 97,344 primary THAs that met the inclusion criteria, 614 THAs had been revised due to deep infection (5-year survival 99.46%). Risk of revision due to deep infection increased throughout the period studied. Compared to the THAs implanted in 1987-1992, the risk of revision due to infection was 1.3 times higher (95%CI: 1.0-1.7) for those implanted in 1993-1997, 1.5 times (95% CI: 1.2-2.0) for those implanted in 1998-2002, and 3.0 times (95% CI: 2.2-4.0) for those implanted in 2003-2007. The most pronounced increase in risk of being revised due to deep infection was for the subgroup of uncemented THAs from 2003-2007, which had an increase of 5 times (95% CI: 2.6-11) compared to uncemented THAs from 1987-1992.
The incidence of deep infection after THA increased during the period 1987-2007. Concomitant changes in confounding factors, however, complicate the interpretation of the results.
[Show abstract][Hide abstract] ABSTRACT: To describe 2 cases of acute renal failure (ARF) associated with the use of antibiotic-laden cement incorporated in total hip arthroplasties (THA).
An 82-year-old female received a right THA with antibiotic-laden cement spacers. She developed ARF 5 months following implantation, concurrent with an elevated serum tobramycin concentration of 5.5 microg/mL. After explantation of the prosthesis and spacers, serum creatinine and antibiotic concentrations decreased to within normal limits. A 79-year-old male received antibiotic-laden cement spacers in a revision of his right THA due to infection. ARF developed 1 1/2 months after the revision; a serum tobramycin concentration was 2.9 microg/mL. Serum creatinine and antibiotic serum concentrations decreased to within normal limits with explantation.
More than 250 000 joint replacements are performed yearly in the US. A common complication is infection, which occurs in 1-2% of primary replacements and 3-4% of revisions of previously infected prostheses. Antibiotic-laden cement is used for prosthesis placement to prevent or treat infection, while minimizing systemic drug exposure. Both patients described here received antibiotic-laden spacers during THA and subsequently developed ARF in conjunction with elevated serum tobramycin concentrations. Use of the Naranjo probability scale and consideration of possible contributing factors suggest a probable association of the antibiotic-laden cement and the development of ARF in these patients.
Antibiotic-laden cement with aminoglycosides and/or vancomycin has the potential for systemic toxicity and should be used according to guidelines and with increased vigilance and prudent monitoring in patients at increased risk for nephrotoxicity.
Annals of Pharmacotherapy 12/2006; 40(11):2037-42. DOI:10.1345/aph.1H173 · 2.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this review, we discuss current advances leading to an exciting change in implant design for orthopedic surgery. The initial biomaterial approaches in implant design are being replaced by cellular-molecular interactions and nanoscale chemistry. New designs address implant complications, particularly loosening and infection. For infection, local delivery systems are an important first step in the process. Selfprotective 'smart' devices are an example of the next generation of orthopedic implants. If proven to be effective, antibiotics or other active molecules that are tethered to the implant surface through a permanent covalent bond and tethering of antibiotics or other biofactors are likely to transform the practice of orthopedic surgery and other medical specialties. This new technology has the potential to eliminate periprosthetic infection, a major and growing problem in orthopedic practice.
Expert Review of Medical Devices 02/2007; 4(1):55-64. DOI:10.1586/17434422.214.171.124 · 1.68 Impact Factor
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