The use of antibiotic-loaded bone cement is an accepted treatment method for infected joint arthroplasties. It is helpful to separate the use of antibiotic-loaded bone cement as a method of prophylaxis as compared with the treatment of an established infection. A low dose of antibiotic-loaded bone cement (< or = 1 g of antibiotic per batch of cement) should be used for prophylaxis, and high-dose antibiotic-loaded bone cement (> 1 g antibiotic per batch of cement) is indicated for treatment. The only commercially available antibiotic-loaded bone cement products are low dose, with the use of tobramycin or gentamicin as an antibiotic selection. High-dose antibiotic-loaded bone cement requires hand mixing by the surgeon to facilitate the use of high dosages and choices of multiple antibiotics. Treatment of infected hip and knee arthroplasties with high-dose antibiotic-loaded bone cement is aided by the use of spacers of various shapes and sizes. These spacers, whether they are static or articulating (mobile), are meant to provide local delivery of antibiotics, stabilization of soft tissues, facilitation of an easier reimplantation, and improved clinical outcomes.
"Two-stage revision has been shown to yield a high rate of infection eradication and survival of the reimplanted THA and is the standard of care in North America for infected THA [10, 11]. An articulating antibiotic spacer helps deliver local antibiotics, maintains joint mobility, and facilitates reimplantation by reducing soft tissue contracture and scar formation . "
[Show abstract][Hide abstract] ABSTRACT: Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure. We defined "eradication of infection" on the basis of negative cultures and clinical diagnosis at least one year after 2(nd) stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.
The Open Orthopaedics Journal 05/2014; 8(1):118-24. DOI:10.2174/1874325020140515002
"Antibioticimpregnated implants are particularly attractive because they not only deliver high tissue levels of antibiotics but also help obliterate the dead space that occurs after bone debridement (Gitelis and Brebach, 2002). For many years, polymethylmethacrylate (PMMA) beads impregnated with vancomycin, tobramycin or gentamicin have been the main local delivery system in osteomyelitis therapy (Hanssen and Spangehl, 2004). PMMA beads, however, are far from being an ideal antibiotic carrier. "
[Show abstract][Hide abstract] ABSTRACT: In this work, osteoconductive composite materials comprising a large volume fraction of a bioresorbable calcium phosphate ceramic (CaP) and a smaller amount of a polycaprolactone polymer (PCL) were studied as a degradable antibiotic carrier material for treatment of osteomyelitis. Beads loaded with 1 and 4 wt.% vancomycin were prepared by admixing dissolved drug to an in situ synthesized dicalcium phosphate (DCP)-PCL or solution-mixed beta-tricalcium phosphate (βTCP)-PCL composite powder followed by high pressure consolidation of the blend at room temperature. Vancomycin release was measured in phosphate-buffered saline (PBS) at 37°C. All the beads gradually released the drug over the period of 4 to 11 weeks, depending on the composite matrix homogeneity and porosity. Mathematical modeling using the Peppas equation showed that vancomycin elution was diffusion controlled. The stability of the antibiotic after high pressure application at room temperature was demonstrated by high-performance liquid chromatography-mass spectrometry (HPLC-MS) studies and MIC testing. The preservation of the structure and activity of vancomycin during the processing of composite beads and its sustained in vitro release profile suggest that high pressure consolidated CaP-PCL beads may be useful in the treatment of chronic bone infections as resorbable delivery vehicles of vancomycin and even of thermally unstable drug substances.
European journal of pharmaceutical sciences: official journal of the European Federation for Pharmaceutical Sciences 05/2014; 62. DOI:10.1016/j.ejps.2014.05.008 · 3.35 Impact Factor
"Two-stage exchange begins with thorough removal of infected tissue and foreign material, followed by irrigation12). The first stage involves insertion of either a static or dynamic antibiotic-impregnated spacer12), most commonly using vancomycin, tobramycin, and gentamicin as the antibiotic12,81). Postoperatively, the patient receives a course of antibiotic treatment, usually for 6 weeks82), followed by reimplantation of a new prosthesis when the clinician deems the infection resolved12,83-85). "
[Show abstract][Hide abstract] ABSTRACT: Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial. This review examines the current understanding in the management of the following aspects of PJI: preoperative risk stratification, preoperative antibiotics, preoperative skin preparation, outpatient diagnosis, assessing for infection in revision cases, improving culture utility, irrigation and debridement, one and two-stage revision, and patient prognostic information. Moreover, ten strategies for the management of periprosthetic knee infection based on available literature, and experience of the authors were reviewed.
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