Two-stage Revision Total Hip Arthroplasty for Periprosthetic Infections Using Antibiotic-impregnated Cement Spacers of Various Types and Materials

Overview

Journal ScientificWorldJournal

Publisher Wiley

Specialty Biology

Date 2014 Jan 2

PMID 24381509

Citations 12

Authors

Katsufumi Uchiyama

Naonobu Takahira

Kensuke Fukushima

Mitsutoshi Moriya

Takeaki Yamamoto

Yojiro Minegishi

Rina Sakai

Moritoshi Itoman

Masashi Takaso

Affiliations

Soon will be listed here.

Abstract

Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α -tricalcium phosphate ( α -TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α -TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation.

Citing Articles

Short-term Success in Treatment of an Acute Hematogenous Periprosthetic Hip Joint Infection with Debridement, Antibiotics, and Implant Retention.

Stephens S, Evans C J Orthop Case Rep. 2024; 14(4):47-52.

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Articulating Hip Spacers with a Constrained Acetabular Liner: Effect of Acetabular Bone Loss and Cementation Quality.

Glenn G, Apple A, Mears S, Barnes C, Stronach B, Siegel E Antibiotics (Basel). 2023; 12(9).

PMID: 37760681 PMC: 10526049. DOI: 10.3390/antibiotics12091384.

Antimicrobials in polymethylmethacrylate: from prevention to prosthetic joint infection treatment: basic principles and risk of resistance.

Sabater-Martos M, Verdejo M, Morata L, Munoz-Mahamud E, Guerra-Farfan E, Martinez-Pastor J Arthroplasty. 2023; 5(1):12.

PMID: 36864538 PMC: 9983184. DOI: 10.1186/s42836-023-00166-7.

Cure rate of infections is not an argument for spacer in two-stage revision arthroplasty of the hip.

Adl Amini D, Wu C, Perka C, Backer H Arch Orthop Trauma Surg. 2022; 143(4):2199-2207.

PMID: 35534712 PMC: 10030410. DOI: 10.1007/s00402-022-04463-9.

Controlling Antibiotic Release from Polymethylmethacrylate Bone Cement.

Wall V, Nguyen T, Nguyen N, Tran P Biomedicines. 2021; 9(1).

PMID: 33401484 PMC: 7824110. DOI: 10.3390/biomedicines9010026.

References

Hsieh P, Shih C, Chang Y, Lee M, Shih H, Yang W . Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004; 86(9):1989-97. View

Hovelius L, Josefsson G . An alternative method for exchange operation of infected arthroplasty. Acta Orthop Scand. 1979; 50(1):93-6. DOI: 10.3109/17453677909024096. View

Hsieh P, Shih C, Chang Y, Lee M, Yang W, Shih H . Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. J Bone Joint Surg Br. 2005; 87(6):770-5. DOI: 10.1302/0301-620X.87B6.15411. View

Disch A, Matziolis G, Perka C . Two-stage operative strategy without local antibiotic treatment for infected hip arthroplasty: clinical and radiological outcome. Arch Orthop Trauma Surg. 2006; 127(8):691-7. DOI: 10.1007/s00402-006-0263-x. View

Uchiyama K, Takahira N, Narahara H, Fukushima K, Yamamoto T, Moriya M . Revision total hip replacement using a cementless interlocking distal femoral stem with allograft-cemented composite and the application of intramedullary and onlay cortical strut allografts: two case reports. J Orthop Sci. 2011; 17(3):323-7. DOI: 10.1007/s00776-011-0084-9. View

Durbhakula S, Czajka J, Fuchs M, Uhl R . Spacer endoprosthesis for the treatment of infected total hip arthroplasty. J Arthroplasty. 2004; 19(6):760-7. DOI: 10.1016/j.arth.2004.02.037. View

Fehring T, Odum S, Berend K, Jiranek W, Parvizi J, Bozic K . Failure of irrigation and débridement for early postoperative periprosthetic infection. Clin Orthop Relat Res. 2012; 471(1):250-7. PMC: 3528942. DOI: 10.1007/s11999-012-2373-9. View

Nusem I, Morgan D . Structural allografts for bone stock reconstruction in two-stage revision for infected total hip arthroplasty: good outcome in 16 of 18 patients followed for 5-14 years. Acta Orthop. 2006; 77(1):92-7. DOI: 10.1080/17453670610045740. View

Leung F, Richards C, Garbuz D, Masri B, Duncan C . Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection?. Clin Orthop Relat Res. 2010; 469(4):1009-15. PMC: 3048283. DOI: 10.1007/s11999-010-1725-6. View

10.

Kalra K, Lin K, Bozic K, Ries M . Repeat 2-stage revision for recurrent infection of total hip arthroplasty. J Arthroplasty. 2010; 25(6):880-4. DOI: 10.1016/j.arth.2009.12.010. View

11.

Younger A, Duncan C, Masri B, McGraw R . The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. J Arthroplasty. 1997; 12(6):615-23. DOI: 10.1016/s0883-5403(97)90133-9. View

12.

Crockarell J, Hanssen A, Osmon D, Morrey B . Treatment of infection with débridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am. 1998; 80(9):1306-13. DOI: 10.2106/00004623-199809000-00009. View

13.

Spangehl M, Masri B, OConnell J, Duncan C . Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg Am. 1999; 81(5):672-83. DOI: 10.2106/00004623-199905000-00008. View

14.

Takahira N, Itoman M, Higashi K, Uchiyama K, Miyabe M, Naruse K . Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer. J Orthop Sci. 2003; 8(1):26-31. DOI: 10.1007/s007760300004. View

15.

Berend K, Lombardi Jr A, Morris M, Bergeson A, Adams J, Sneller M . Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2012; 471(2):510-8. PMC: 3549176. DOI: 10.1007/s11999-012-2595-x. View

16.

Sasaki T, Ishibashi Y, Katano H, Nagumo A, Toh S . In vitro elution of vancomycin from calcium phosphate cement. J Arthroplasty. 2005; 20(8):1055-9. DOI: 10.1016/j.arth.2005.03.035. View

17.

Kostuik J, Alexander D . Arthrodesis for failed arthroplasty of the hip. Clin Orthop Relat Res. 1984; (188):173-82. View

18.

Wroblewski B . One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res. 1986; (211):103-7. View

19.

Lim S, Moon Y, Park Y . Is extended trochanteric osteotomy safe for use in 2-stage revision of periprosthetic hip infection?. J Arthroplasty. 2011; 26(7):1067-71. DOI: 10.1016/j.arth.2011.03.001. View

20.

Dairaku K, Takagi M, Kawaji H, Sasaki K, Ishii M, Ogino T . Antibiotics-impregnated cement spacers in the first step of two-stage revision for infected totally replaced hip joints: report of ten trial cases. J Orthop Sci. 2009; 14(6):704-10. DOI: 10.1007/s00776-009-1406-z. View