Successful treatment of total hip and knee infection with articulating antibiotic components - A modified treatment method
ABSTRACT There are many problems associated with the use of articulating antibiotic cement spacer blocks and articulating components in the two-stage treatment of total hip replacement and total knee replacement infections. These include loss of motion during and after treatment, bone loss, generation of cement debris, inadequate dosing of cement with the appropriate antibiotic, and biologic failure. Forty-four patients with 54 consecutive periprosthetic hip and knee infections (31 septic total knee arthroplasties and 23 septic total hip arthroplasties) had treatment with a modified two-stage reimplantation protocol using articulating components made of antibiotic-cement-only prosthetic components and antibiotic-cement-covered prosthetic components between January 1995 and May 2002. Second-stage revision, after six weeks of parenteral antibiotics, was completed an average of 84 days after the first stage. A minimum two-year followup after final treatment is evaluated. One of the 23 total hip replacement infections persisted or recurred with the original organism(s) after treatment (95.7% success) as did two of the 31 total knee replacement infections (93.5% success). Combined success rate was 94.4%. This modified treatment method incorporates early range of motion during first-stage treatment with articulating components that provide local high-dose elution of broad-spectrum antibiotics, provides the flexibility of customizing the antibiotic cement components with culture-directed antibiotics, and results in a high biologic success rate.
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ABSTRACT: Periprosthetic infection after total hip arthroplasty is a devastating complication. A two-stage protocol with the temporary insertion of an antibiotic-laden cement spacer is the gold standard treatment for chronic infections (Clinics (Sao Paulo) 62:99-108, 2007; Clin Orthop Relat Res 427:37-46, 2004; J Arthroplast 14:175-181, 1999; Clin Orthop Relat Res 467:1848-1858, 2009; J Arthroplast 20:874-879, 2005; J Arthroplast 24: 607-613, 2009; Clin Orthop Relat Res 469:1009-1015, 2011; Hip Int 20:26-33, 2010; J Arthroplast 24:1051-1060, 2009; J Bone Joint Surg Br 91:44-51, 2009). Some authors, however (Int J Med Sci 6(5):265-73, 2009), report mechanical complication rates with spacers in excess of 50 %.Therefore, the aim of this study is to determine (1) the mechanical complications associated with enclosed articulating partial load-bearing spacers when treating periprosthetic hip infections and (2) possible factors of influence. Between 2000 and 2011, 138 patients received an antibiotic-laden cement spacer as part of a two-stage protocol. The overall frequency of complications (spacer fracture, dislocation, femoral fracture with enclosed spacer, spacer fracture with dislocation, protusion into the pelvis) was recorded. Potential influencing factors ('mould spacer' vs. handmade spacer, Steinmann pins as an endoskeleton, addition of vancomycin into the spacer) were analysed. The mean age at the time of the first stage operation was 69.3 ± 10.5 years. Overall, 27 of 138 patients suffered one of the above-mentioned complications (19.6 %). Spacer fracture occurred in 12 cases (8.7 %) and dislocation in another 12 (8.7 %). There was also one periprosthetic femoral fracture with a spacer in situ, one dislocation with a simultaneous spacer fracture, and one protrusion into the pelvis (0.7 % each). Our data revealed an overall complication rate of 13.2 % with a mould spacer enclosing a Steinman pin. The mechanical complication rate of over 50 % reported by some authors cannot be confirmed. As a consequence, we recommend using a mould spacer with an enclosed Steinman pin as an endoskeleton to minimize the complication rate.International Orthopaedics 01/2015; 39(5). DOI:10.1007/s00264-014-2636-z · 2.02 Impact Factor
Article: Prosthetic Joint Infections[Show abstract] [Hide abstract]
ABSTRACT: Prosthetic joint infections (PJIs) are often managed by surgical treatment of irrigation and debridement (I&D) in acute infections, and 1-stage or 2-stage exchange arthroplasty in chronic infections. Patients who undergo I&D have had lower success rates compared with patients who undergo exchange arthroplasty, especially if resistant organisms are encountered. In patients who cannot undergo surgical reconstruction, resection arthroplasty, fusion, or amputation may be performed. Patients who are poor surgical candidates may be treated with chronic antibiotic suppression. Despite these treatments, PJIs may not be fully eradicated, and future research should be performed to prevent the development of PJIs. Copyright © 2014 Elsevier Inc. All rights reserved.Surgical Clinics of North America 12/2014; DOI:10.1016/j.suc.2014.08.009 · 1.93 Impact Factor