ANTIBIOTIC-IMPREGNATED ARTICULAR CEMENT SPACER FOR TREATMENT OF PERIPROSTHETIC JOINT INFECTION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHANGWenming , LIWenbo , BAIGuochang , HUANGZida , WUHaiyi

Department of Joint Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou Fujian, 350001, P. R. China;

Corresponding author：

ZHANGWenming, Email: zhangwm0591@163.com

Keywords：

Artificial joint; Periprosthetic joint infection; Revision; Cement; Antibiotics

DOI：

10.7507/1002-1892.20150091

Video：

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Objective To investigate the current problems and corresponding solutions regarding the use of antibiotic-impregnated cement spacer for the treatment of periprosthetic joint infection (PJI). Methods A retrospective analysis was made on the clinical data of 27 patients with PJI who underwent two-stage revision with antibiotic-impregnated cement spacer between January 2001 and January 2013. There were 12 males and 15 females, with an average age of 62.7 years (range, 25-81 years). All arthroplasties were unilateral, including 19 hip PJI and 8 knee PJI. The mean duration from primary arthroplasty to PJI was 25 months (range, 3-252 months). After infection was controlled with the antibiotic-impregnated cement spacer combined with systematic antibiotics treatment, two-stage revision was performed. The effectiveness was evaluated. Results One patient died of myocardial infarction at 2 days after surgery. Infection was controlled, and two-stage revision was successfully performed in 19 patients; deep venous thrombosis occurred in 1 of 3 patients who experienced hip spacer fractures, which was cured after conservative management. The spacers were removed and bacteria-sensitive antibiotics was used because of recurrent infections after the first-stage surgery in 7 patients; 3 patients gave up treatment because infection was not controlled, 4 patients received revision after infection was controlled. Twenty-three patients were followed up 1-5 years (mean, 2.3 years). The average Harris hip score and KSS score at 1 years after revision were significantly improved when compared with preoperative ones (P<0.05). In the 8 patients with gram-negative or fungus infection, 7 were found to have recurrent infection after the first-stage surgery; in the 12 patients with gram-positive infection, no recurrent infection was found. Failed treatment was observed in 1 patient with gram-positive and gram-negative infections and 2 with fungus infection, respectively. Conclusion Antibiotic-impregnated cement spacer has a satisfactory effectiveness for PJI. However, complication of spacer fracture should be noted, especially hip spacers. If the pathogen is gram-negative bacteria or fungus, the implanted spacer may increase the possibility of recurrent infection.

Citation： ZHANGWenming, LIWenbo, BAIGuochang, HUANGZida, WUHaiyi. ANTIBIOTIC-IMPREGNATED ARTICULAR CEMENT SPACER FOR TREATMENT OF PERIPROSTHETIC JOINT INFECTION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(4): 420-425. doi: 10.7507/1002-1892.20150091 Copy

1.	Meek RM, Masri BA, Dunlop D, et al. Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg (Am), 2003, 85-A(10):1888-1892.
2.	Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1):e1-e25.
3.	Mirra JM, Amstutz HC, Matos M, et al. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res, 1976, (117):221-240.
4.	Feldman DS, Lonner JH, Desai P, et al. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg (Am), 1995, 77(12):1807-1813.
5.	Cobo J, Miguel LG, Euba G, et al. Early prosthetic joint infection:outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect, 2011, 17(11):1632-1637.
6.	Peel TN, Cheng AC, Choong PF, et al. Early onset prosthetic hip and knee joint infection:treatment and outcomes in Victoria, Australia. J Hosp Infect, 2012, 82(4):248-253.
7.	Cooper HJ, Della Valle CJ. The two-stage standard in revision total hip replacement. Bone Joint J, 2013, 95-B(11 Suppl A):84-87.
8.	闫韵飞, 郭亭, 周利武, 等. 抗生素骨水泥占位器在髋关节置换后感染二期翻修中的应用. 中国组织工程研究, 2012, 16(4):673-678.
9.	Romanò CL, Romanò D, Albisetti A, et al. Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results. Hip Int, 2012, 22 Suppl 8:S46-53.
10.	张强, 周勇刚, 陈继营, 等. 术中自制临时关节型抗生素骨水泥占位器治疗人工膝关节置换术后感染. 中国骨伤, 2013, 26(2):119-123.
11.	Emerson RH Jr, Muncie M, Tarbox TR, et al. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relate Res, 2002, (404):132-138.
12.	Fehring TK, Odum S, Calton TF, et al. Articulating versus static spacers in revision total knee arthroplasty for sepsis. Clin Orthop Relate Res, 2000, (380):9-16.
13.	黄德勇, 张洪, 周乙雄, 等. 抗生素骨水泥间隔物在全髋关节置换术后感染Ⅱ期翻修术中的应用. 中华创伤外科杂志, 2007, 23(6):403-406.
14.	Vorndran E, Spohn N, Nies B, et al. Mechanical properties and drug release behavior of bioactivated PMMA cements. J Biomater Appl, 2012, 26(5):581-594.
15.	Cabrita HB, Croci AT, Camargo OP, et al. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo), 2007, 62(2):99-108.
16.	Sendi P, Rohrbach M, Graber P, et al. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis, 2006, 43(8):961-967.
17.	Tande AJ, Patela R. Prosthetic joint infections. Clin Microbiol Rev, 2014, 27(2):302-345.
18.	Font-Vizcarra L, García S, Martínez-Pastor JC, et al. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8):2238-2243.
19.	Qu X, Zhai Z, Wu C, et al. Preoperative aspiration culture for preoperative diagnosis of infection in total hip or knee arthroplasty. J Clin Microbiol, 2013, 51(11):3830-3834.
20.	Jacobs C, Christensen CP, Berend ME. Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection. J Am Acad Orthop Surg, 2009, 17(6):356-368.

1. Meek RM, Masri BA, Dunlop D, et al. Patient satisfaction and functional status after treatment of infection at the site of a total knee arthroplasty with use of the PROSTALAC articulating spacer. J Bone Joint Surg (Am), 2003, 85-A(10):1888-1892.
2. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1):e1-e25.
3. Mirra JM, Amstutz HC, Matos M, et al. The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res, 1976, (117):221-240.
4. Feldman DS, Lonner JH, Desai P, et al. The role of intraoperative frozen sections in revision total joint arthroplasty. J Bone Joint Surg (Am), 1995, 77(12):1807-1813.
5. Cobo J, Miguel LG, Euba G, et al. Early prosthetic joint infection:outcomes with debridement and implant retention followed by antibiotic therapy. Clin Microbiol Infect, 2011, 17(11):1632-1637.
6. Peel TN, Cheng AC, Choong PF, et al. Early onset prosthetic hip and knee joint infection:treatment and outcomes in Victoria, Australia. J Hosp Infect, 2012, 82(4):248-253.
7. Cooper HJ, Della Valle CJ. The two-stage standard in revision total hip replacement. Bone Joint J, 2013, 95-B(11 Suppl A):84-87.
8. 闫韵飞, 郭亭, 周利武, 等. 抗生素骨水泥占位器在髋关节置换后感染二期翻修中的应用. 中国组织工程研究, 2012, 16(4):673-678.
9. Romanò CL, Romanò D, Albisetti A, et al. Preformed antibiotic-loaded cement spacers for two-stage revision of infected total hip arthroplasty. Long-term results. Hip Int, 2012, 22 Suppl 8:S46-53.
10. 张强, 周勇刚, 陈继营, 等. 术中自制临时关节型抗生素骨水泥占位器治疗人工膝关节置换术后感染. 中国骨伤, 2013, 26(2):119-123.
11. Emerson RH Jr, Muncie M, Tarbox TR, et al. Comparison of a static with a mobile spacer in total knee infection. Clin Orthop Relate Res, 2002, (404):132-138.
12. Fehring TK, Odum S, Calton TF, et al. Articulating versus static spacers in revision total knee arthroplasty for sepsis. Clin Orthop Relate Res, 2000, (380):9-16.
13. 黄德勇, 张洪, 周乙雄, 等. 抗生素骨水泥间隔物在全髋关节置换术后感染Ⅱ期翻修术中的应用. 中华创伤外科杂志, 2007, 23(6):403-406.
14. Vorndran E, Spohn N, Nies B, et al. Mechanical properties and drug release behavior of bioactivated PMMA cements. J Biomater Appl, 2012, 26(5):581-594.
15. Cabrita HB, Croci AT, Camargo OP, et al. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics (Sao Paulo), 2007, 62(2):99-108.
16. Sendi P, Rohrbach M, Graber P, et al. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis, 2006, 43(8):961-967.
17. Tande AJ, Patela R. Prosthetic joint infections. Clin Microbiol Rev, 2014, 27(2):302-345.
18. Font-Vizcarra L, García S, Martínez-Pastor JC, et al. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8):2238-2243.
19. Qu X, Zhai Z, Wu C, et al. Preoperative aspiration culture for preoperative diagnosis of infection in total hip or knee arthroplasty. J Clin Microbiol, 2013, 51(11):3830-3834.
20. Jacobs C, Christensen CP, Berend ME. Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection. J Am Acad Orthop Surg, 2009, 17(6):356-368.

Chinese Journal of Reparative and Reconstructive Surgery

ANTIBIOTIC-IMPREGNATED ARTICULAR CEMENT SPACER FOR TREATMENT OF PERIPROSTHETIC JOINT INFECTION

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