Periprosthetic hip infection treated with two-stage stage-one Select Spacer– complication rate and restoration of anatomy

Abstract Objectives There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the clamped CSD group and open CSD group after surgery. Drainage samples of joint fluids (n=160) were collected every 24 hours for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results There was no significant difference in the decrease of vancomycin (p=0.917) and meropenem concentration (P=0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. Coli. Conclusions The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.

Download Full-text

Compared with two-stage revision, retained spacers have a similar infection-relief rate and a higher complication rate

10.21203/rs.3.rs-34998/v3 ◽

2020 ◽

Author(s):

Yuanqing Cai ◽

Xinyu Fang ◽

Yi Lin ◽

Zida Huang ◽

Chaofan Zhang ◽

...

Keyword(s):

Clinical Outcomes ◽

Complication Rate ◽

Joint Infection ◽

Type I ◽

Test Results ◽

Two Stage ◽

Spacer Group ◽

Laboratory Test Results ◽

Comorbidity Index ◽

Relief Rate

Abstract Background: Periprosthetic joint infection (PJI) is a devastating complication for joint arthroplasty, there are many challenges in therapy. The treatment of PJI including surgery and systemic administration of antibiotics. As for surgery, two-stage revision is regarded as the “gold standard” for PJI treatment presently, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation, this spacer, namely, “destination joint spacer”. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).

Download Full-text

Does the use of a closed-suction drain reduce the effectiveness of an antibiotic-loaded spacer in two-stage exchange Arthroplasty for Periprosthetic hip infection? A prospective, randomized, controlled study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2974-5 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Chi Xu ◽

Cheng-Qi Jia ◽

Feng-Chih Kuo ◽

Wei Chai ◽

Ming-Hua Zhang ◽

...

Keyword(s):

Control Group ◽

Cement Spacer ◽

Two Stage ◽

E Coli ◽

Closed Suction ◽

Randomized Controlled ◽

Suction Drain ◽

Exchange Arthroplasty ◽

Closed Suction Drain ◽

Hip Infection

Abstract Background There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli. Conclusions The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty. (Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.)

Download Full-text

Infección protésica de cadera. Recambio en dos tiempos en una serie de 50 casos.

Revista Española de Cirugía Osteoarticular ◽

10.37315/sotocav20202835599 ◽

2020 ◽

pp. 99-107

Author(s):

C SÁNCHEZ-LOSILLA ◽

J DIRANZO-GARCÍA ◽

V ESTREMS-DÍAZ ◽

F JARA-GARCÍA ◽

Antonio BRU-POMER ◽

...

Keyword(s):

Chronic Infection ◽

Hip Prosthesis ◽

Functional Results ◽

Implant Survival ◽

Cure Rate ◽

Two Stage ◽

Revision Procedure ◽

Hip Infection ◽

Component Loosening

Chronic infection in hip replacement is an important complication with a complex treatment, that is solved by adequate antibiotic therapy together with single-stage exchange or two-stage exchange. We present a descriptive and retrospective study of a series of 50 consecutive patients operated on in our center with a diagnosis of chronic infection of the hip prosthesis between 2007 and 2018 with a two-stage exchange. At a mean follow-up of 52 months, the overall implant survival was 89%, with a 91% infection cure rate. The most frequent microorganism isolated was Staphylococcus epidermidis. The mean score achieved on the HHS was 82,4 points and 1.67 points on the visual analogue scale. We obtained better functional results (p=0,021) in those patients who had a preformed antibiotic-loaded spacer in the first surgical stage. As complications, we recorded four cases of prosthetic reinfection (8,7%), three cases of dislocation (6,5%), and one case of postsurgical hematoma (4,6%). No case of neurovascular injury or component loosening was recorded. According to the showed results, we consider that two-stage revision procedure, although it is a demanding surgery, is an effective method for the treatment of periprosthetic hip infection, with high implant survival and erradication of the infection.

Download Full-text

Does the Use of a Closed-Suction Drain Reduce the Effectiveness of an Antibiotic-loaded Spacer in Two-Stage Exchange Arthroplasty for Periprosthetic Hip Infection? A Prospective, Randomized, Controlled Study

10.21203/rs.2.12102/v3 ◽

2019 ◽

Author(s):

Chi Xu ◽

Cheng-Qi Jia ◽

Feng-Chih Kuo ◽

Wei Chai ◽

Ming-Hua Zhang ◽

...

Keyword(s):

Control Group ◽

Cement Spacer ◽

Two Stage ◽

E Coli ◽

Closed Suction ◽

Randomized Controlled ◽

Suction Drain ◽

Exchange Arthroplasty ◽

Closed Suction Drain ◽

Hip Infection

Abstract Background: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. Methods: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n=160) were collected every 24 hours for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. Results: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p=0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P=0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. Coli . Conclusions: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.

Download Full-text