Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty.
ABSTRACT The purpose of this study was to assess the systemic safety and potential adverse effects of using a high-dose antibiotic-impregnated cement spacer after resection arthroplasty of an infected total knee replacement. Between October 2000 and December 2002, 36 knees (34 patients) had a resection arthroplasty of an infected total knee prosthesis with placement of a high-dose antibiotic impregnated cement spacer. There were 24 men and 10 women with a mean age of 66.5 years (range, 48-84 years). All spacers placed contained an average of 3.4 batches of cement with an average total dose of 10.5 g of vancomycin (range, 3-16 g) and 12.5 g of gentamicin (range, 3.6-19.2 g). All patients were followed up post-operatively until reimplantation for evidence of renal failure. The preoperative creatinine ranged from 0.7 to 1.8 mg/dL. All patients were concomitantly treated with 6 weeks of intravenous organism-specific antibiotics. One patient with normal preoperative renal function (Cr 0.7 mg/dL) had a perioperative 1-day transient rise in serum creatinine (1.7 mg/dL) postoperatively that subsequently normalized. No patients showed any clinical evidence of acute renal insufficiency, failure, or other systemic side effects of the antibiotics. Treatment of patients with an infected total knee arthroplasty with high-dose vancomycin and gentamicin antibiotic spacers seems to be clinically safe.
- SourceAvailable from: Antonia F Chen[Show abstract] [Hide abstract]
ABSTRACT: Antibiotic-loaded bone cement (ALBC) is commonly used for antibiotic delivery during total joint arthroplasty (TJA) for prevention or treatment of periprosthetic joint infection (PJI). ALBC is commonly used in two-stage exchange arthroplasty with static and dynamic spacers, beads, rods, and other custom spacers. The use of commercially available or hand-made ALBC for primary and revision TJA to prevent infection has also been studied. Commonly used antibiotics include gentamicin, tobramycin, and vancomycin powder, and these antibiotics can be used alone or in combination, depending on the organism present. ALBC can be prepared by hand mixing to increase porosity and improve antibiotic elution or by vacuum-mixing to improve tensile fatigue strength. Vacuum-mixed cement is predominantly used in primary TJA, whereas hand-mixed cement is often used in two-stage exchange arthroplasty for shaping spacers and beads. Inadequate strength of ALBC spacers can result in mechanical failure, including fracture or dislocation of spacers. Additionally, studies have demonstrated that the use of antibiotics in cement, especially aminoglycosides like gentamicin and tobramycin that can elute into the bloodstream, may result in acute renal failure. Using antibiotics in ALBC can also theoretically increase antibiotic resistance and the likelihood of obtaining a negative culture if subsequent aspirations are performed. Overall, ALBC is an effective medical implant tool that can be used for treating and preventing PJI.Journal of Long-Term Effects of Medical Implants 01/2014; 24(2-3):89-97.
- [Show abstract] [Hide abstract]
ABSTRACT: We developed biodegradable drug-eluting nanofiber-enveloped implants that provided sustained release of vancomycin and ceftazidime. To prepare the biodegradable nanofibrous membranes, poly(D,L)-lactide-co-glycolide and the antibiotics were first dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. They were electrospun into biodegradable drug-eluting membranes, which were then enveloped on the surface of stainless plates. An elution method and a high-performance liquid chromatography assay were employed to characterize the in vivo and in vitro release rates of the antibiotics from the nanofiber-enveloped plates. The results showed that the biodegradable nanofiber-enveloped plates released high concentrations of vancomycin and ceftazidime (well above the minimum inhibitory concentration) for more than 3 and 8 weeks in vitro and in vivo, respectively. A bacterial inhibition test was carried out to determine the relative activity of the released antibiotics. The bioactivity ranged from 25% to 100%. In addition, the serum creatinine level remained within the normal range, suggesting that the high vancomycin concentration did not affect renal function. By adopting the electrospinning technique, we will be able to manufacture biodegradable drug-eluting implants for the long-term drug delivery of different antibiotics.International Journal of Nanomedicine 01/2014; 9:4347-4355. · 4.20 Impact Factor