The choice of a spacer at the first stage of treatment for late deep periprosthetic hip joint infection

Abstract. Introduction Periprosthetic infection in hip arthroplasty is a social and economic problem. Its main reason is multidrug resistance of microorganisms. Purpose To evaluate the effectiveness of the first stage in two-stage revision arthroplasty for the treatment of deep periprosthetic infection of the hip joint by improving the constructive and antibacterial features of spacers. Materials and methods The treatment results of 127 patients with late deep periprosthetic hip joint infection who underwent two-stage revision arthroplasty in the period from 2015 to 2019 were analyzed. In the first group, 42 patients were fitted with a two-component (total) spacer based on the developed antimicrobial composition of bone cement with gentamicin, antiseptics and polymer (patent RU 191236). In the second group, a two-component spacer (patent RU 174697) based on conventional bone cement with gentamicin was implanted in 43 patients; the third group of 42 patients had a preformed spacer. Results A bactericidal and antiadhesive, nontoxic composition based on bone cement with gentamicin with antiseptics poviargol, dioxidine and high molecular weight polyvinylpyrrolidone with a prolonged action for 348 days against gentamicin-resistant staphylococci has been developed. All patients underwent the first stage of hip arthroplasty with removal of the implant and installation of a spacer. Recurrence of periprosthetic infection was observed in 1 (2.3 %) patient of the first group, in 5 (11.6 %) in the second and in 6 (14.2 %) patients of the third group. Non-infectious complications such as spacer dislocation and instability were observed in 12 cases, one case (2.3 %) in the first, 2 (4.6 %) in the second and 9 (21.4 %) in the third group. The average time from the first stage of treatment to the second stage of re-implantation was 7.5 months (range, 4–13 months). Discussion According to the literature, the introduction of new antibiotics into the bone cement with gentamicin does not increase the antimicrobial action of the spacer, especially against antibiotic-resistant isolates, and the use of a preformed spacer contributes to an increase in the number of non-infectious complications. Antiseptics with different mechanisms of action are able to act on antibiotic-resistant bacteria, and the polymer can prolong this effect. Conclusions Creation of two-component spacers based on bone cement with gentamicin using antiseptics with different mechanisms of action and polymer promotes long-term bactericidal action of the spacer, which leads to effective sanation of the joint area, reducing non-infectious complications.

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Treatment Outcomes of Periprosthetic Joint Infection in HIV-positive Patients

Traumatology and Orthopedics of Russia ◽

10.21823/2311-2905-2019-25-4-117-125 ◽

2019 ◽

Vol 25 (4) ◽

pp. 117-125

Author(s):

A. S. Tryapichnikov ◽

A. M. Ermakov ◽

N. M. Klyushin ◽

Yu. V. Ababkov ◽

A. B. Stepanayn ◽

...

Keyword(s):

High Efficiency ◽

Periprosthetic Infection ◽

Clinical Laboratory ◽

Joint Infection ◽

Revision Arthroplasty ◽

Harris Hip Score ◽

Hiv Positive ◽

Large Joint ◽

Number Of Publications ◽

Asymptomatic Phase

Relevance. There is a limited number of publications reporting outcomes of primary large joint arthroplasty in patients with human immunodeficiency virus (HIV). The authors were unable to find papers on revision arthroplasty in patients with periprosthetic infection. Purpose of the study — to evaluate short term outcomes after revision arthroplasty in HIV-positive patients with periprosthetic infection of the hip and knee joint. Materials and methods. 13 HIV-positive patients with periprosthetic infection of the hip (10 cases) and knee (3 cases) joint underwent treatment in the period from 2015 to 2019. Patients were examined by clinical, laboratory and roentgenological methods. Harris Hip Score and Knee Society Score were used for evaluation prior to and after the surgery. Results. Mean follow up period was 21,4±2,6 months. Successful two-stage treatment was performed in two (15,4%) out of 13 patients with periprosthetic infection. In 5 cases (38,5%) control over infection was achieved by resection arthroplasty, and in one case (7,7%) – by arthrodesis. Five patients (38,5%) refused from interchange of spacer to prosthesis. Mean Harris Hip score demonstrated insignificant increase postoperatively — from 45,3±2,2 to 52,2±4,15 (р = 0,2). Conclusion. Despite following the international protocols for treatment of implant-associated infection the infection recurrence rate in HIV-positive patients in the asymptomatic phase remains very high. Efficiency of twostage treatment using antibacterial spacers in the present group of patients amounted only to 15,4%.

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Clinical and microbiological characteristics of periprosthetic hip and knee infections

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2020.3.237-240 ◽

2020 ◽

pp. 237-240

Author(s):

Vladimir A. Ivantsov ◽

I.P. Bogdanovich ◽

V.V. Lashkovskiy ◽

V.S. Anosov

Keyword(s):

Surgical Treatment ◽

Knee Joint ◽

Hip Joint ◽

Joint Replacement ◽

Periprosthetic Infection ◽

Joint Infection ◽

Knee Joints ◽

Knee Joint Replacement ◽

Hip Joint Replacement ◽

Total Knee

Objective. To characterize periprosthetic joint infection in patients undergoing a total hip and knee joint replacement. Materials and Methods. A total of 77 patients with periprosthetic infection following hip and knee joint replacement hospitalized in Grodno City Clinical Hospital were studied over the period of 2014-2018. Wound discharge, tissue samples, and fistula’s wall swab were used for microbiological tests. The analysis of surgical treatment of patients with deep periprosthetic knee and hip joint infection has been performed. Results. Periprosthetic infection after hip joint arthroplasty was observed in 32 (41.6%) patients, and after total knee joint arthroplasty in 45 (58.4%) patients. Surgical treatment was performed in 18 (56.3%) and 32 (71.1%) patients with periprosthetic infection following total knee and hip joint replacement, respectively. A total of 10 (31.2%) of 32 cultures from patients with periprosthetic infection after total hip joint replacement and 8 (17.8%) of 45 cultures from patients with periprosthetic infection after total knee joint replacement were positive. Overall, Staphylococcus aureus was detected in 9 (50%) of 18 positive cultures. Gram-negative aerobic bacteria (Acinetobacter baumannii, Klebsiella pneumoniae Pseudomonas aeruginosa) were detected in 4⁄10 and 5⁄8 of positive cultures from patients with periprosthetic infection of hip and knee joints, respectively. Conclusions. The most common pathogens causing periprosthetic infection of hip and knee joints were S. aureus (50%) and Gram-negative bacteria. The surgical treatment was performed in 71.4% of patients with periprosthetic joint infection.

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Effi ciency of two-stage revision arthroplasty in management of periprosthetic knee and hip joint infection

Genij Ortopedii ◽

10.18019/1028-4427-2018-24-3-321-326 ◽

2018 ◽

Vol 24 (3) ◽

pp. 321-326 ◽

Cited By ~ 3

Author(s):

A.M. Ermakov ◽

◽

N.M. Kliushin ◽

Iu.V. Ababkov ◽

A.S. Triapichnikov ◽

...

Keyword(s):

Hip Joint ◽

Joint Infection ◽

Revision Arthroplasty ◽

Two Stage ◽

Effi Ciency

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The Effect of Antiseptics in the Prophylaxis of Infection in Orthopaedic Surgery

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-0608-5292 ◽

2018 ◽

Vol 156 (05) ◽

pp. 567-573

Author(s):

Martin Lüdemann ◽

Pablo Munoz ◽

Martin Wagner ◽

Uwe Malzahn ◽

Konstantin Horas ◽

...

Keyword(s):

Randomised Controlled Trials ◽

Periprosthetic Infection ◽

Joint Infection ◽

Revision Arthroplasty ◽

Cochrane Library ◽

Controlled Trials ◽

Orthopaedic Implants ◽

Wound Irrigation ◽

Evidence Level ◽

Randomised Controlled

Abstract Introduction Over the past decade, the incidence of revision arthroplasty has increased substantially. One of the main reasons for revision arthroplasty is periprosthetic joint infection, often resulting in multiple surgical interventions with variable success and poor clinical outcome. Intraoperative wound irrigation has been proposed to reduce bacterial contamination and thus the risk of periprosthetic infection. However, there is currently no widely accepted recommendation for the use of topical antiseptics within the operative setting for primary implantation. We performed a systematic review of studies pertaining to the use of intraoperative topical antiseptics and their effectiveness in preventing infection of orthopaedic implants. Materials and Methods A comprehensive literature search including MEDLINE (PubMed), Cochrane Library, and Current Contents Medicine (CCMED-Medpilot) was performed according to a standardised protocol. Results Overall, 1905 articles were initially assessed. Four studies met the inclusion criteria and remained for further analysis, comprising two prospective cohort studies using retrospective control groups (evidence level II – III) and two randomised controlled trials (evidence level I). 0.35% Povidone-iodine (PVP-I) was used in three of these studies and a solution of 6.25% PVP-I and 6.25%-hydrogen peroxide (H2O2) in one study for intraoperative wound irrigation. There was a clear trend in all studies suggesting that intraoperative topical antiseptics are effective in preventing periprosthetic infection. Conclusion Although no clear regimen can be recommended, the available literature indicates that the use of intraoperative topical antiseptics is of clinical relevance in preventing infection of orthopaedic implants. Further randomised controlled trials are recommended.

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Treatment of deep periprosthetic hip infection with articulating cement-antibiotic spacers with silver plates and antibiotics

Bukovinian Medical Herald ◽

10.24061/2413-0737.xxv.1.96.2020.14 ◽

2021 ◽

Vol 25 (2(98)) ◽

pp. 89-95

Author(s):

M. Muller ◽

Ya. Vasylchyshyn ◽

R. Dorschfeld ◽

V. Protsiuk

Keyword(s):

Hip Joint ◽

Medical Center ◽

Joint Infection ◽

Revision Arthroplasty ◽

Long Term Results ◽

Two Stage ◽

Results Of Treatment ◽

Artificial Hip Joint ◽

Antibiotic Spacer

The aim of this work is to improve the results of treatment of patients with a deep periprosthetic hip joint infection by using an articulating cement-antibiotic spacer in combination with silver plates and antibiotics.Material and methods. The treatment outcomes of 52 patients operated at the Swedish-Ukrainian Angelholm Medical Center for the period from 2017 to 2020, who underwent two-stage revision arthroplasty for the deep periprosthetic infectious-inflammatory process of the hip joint, were studied. In addition, 9 patients were examined in whom, during the first stage of a two-stage treatment of an artificial hip joint infection, an articulating cement-antibiotic spacer made of bone cement with a silver content was developed.Research results. Long-term results of two-stage revision arthroplasty with the introduction of our proposed cement-antibiotic spacers were studied in 49 (94.2%) patients. Among them, 9 patients used silver plates, which showed good patient tolerance and in all cases the infection was overcome. In 49 patients in whom the long-term results of two-stage revision hip arthroplasty were studied, 44 (89.8%) achieved eradication of the infection with restoration of the function of the operated limb. We rated such results as good. The average HHS score in this group was 87.18 ± 6.44 points.Conclusions. An innovative method of treatment of deep periprosthetic infection of the hip joint has been introduced into clinical practice, which consists in increasing the effectiveness of using an articulating cement antibiotic spacer by adding silver plates to it and, in addition, an antibiotic.

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Short-term results of treatment of staphylococcal periprosthetic hip joint infection with combined antibiotics and bacteriophages treatment

Acta biomedica scientifica ◽

10.29413/abs.2021-6.4.5 ◽

2021 ◽

Vol 6 (4) ◽

pp. 50-63

Author(s):

E. A. Fedorov ◽

S. O. Kretien ◽

A. G. Samokhin ◽

N. V. Tikunova ◽

A. A. Korytkin ◽

...

Keyword(s):

Antibiotic Resistance ◽

Hip Joint ◽

Bacterial Infections ◽

Periprosthetic Infection ◽

Joint Infection ◽

Practical Importance ◽

Antibiotic Tolerance ◽

Simultaneous Application ◽

Surgical Interventions ◽

Hip Joint Endoprosthesis

Infectious complications after primary implantation of the hip joint are 0.5–3 %, and in the case of re-endoprosthetics, the risk of periprosthetic infection can reach 30 %. Also, we should not forget about the high percentage (16–20 %) of recurrence of periprosthetic infection of the hip joint, which leads to an unsatisfactory result of treatment up to amputation of a limb or even death of the patient. The reasons for the recurrence of the infectious process can be antibiotic resistance and antibiotic tolerance of microorganisms, as well as the ability of microorganisms to form biofilms on implants. In this regard, there is a constant need to search for alternative means of antimicrobial therapy, as well as to select the optimal ways of their delivery and deposition, which is of practical importance when performing surgical interventions in traumatology and orthopedics to protect the implantable structure from possible infection of the surgical site. One of the methods currently available to combat bacterial infections acquired antibiotic resistance and antibiotic tolerance is the use of natural viruses that infect bacterial bacteriophages. The above suggests a more effective suppression of periprosthetic infection, including persisters that deviate from antibiotics. It is, as a rule, associated with biofilms if used in conjunction with antibiotics and phages, when the use of bacteriophages predetermines the effectiveness of treatment. With the use of sensitive bacteriophages in the treatment of periprosthetic infections, a significant (p = 0.030) reduction in the rate of recurrence of infection (from 31 to 4.5 %) was observed. The use of lytic bacteriophages in traumatology and orthopedics is of great interest for phagotherapy of infections caused by antibiotic-resistant and biofilm-forming strains of bacteria. A clinical study using a single-stage surgical revision with simultaneous application of antibiotics and phages in the treatment of deep periprosthesis infection of the hip joint endoprosthesis, followed by 12 months follow-up for periprosthetic infection recurrence, demonstrated the effectiveness of the use of combined antibiotic and bacteriophages treatment.

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The use of antibiotic-loaded bone cement does not increase antibiotic resistance after primary total joint arthroplasty

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06649-x ◽

2021 ◽

Author(s):

Kaspar Tootsi ◽

Victoria Heesen ◽

Martin Lohrengel ◽

Andreas Eugen Enz ◽

Sebastian Illiger ◽

...

Keyword(s):

Antibiotic Resistance ◽

Bone Cement ◽

Total Joint Arthroplasty ◽

Joint Infection ◽

Joint Arthroplasty ◽

Resistant Bacteria ◽

Coagulase Negative Staphylococci ◽

Level Of Evidence ◽

Antibiotic Resistant ◽

International Multicenter Study

Abstract Purpose One of the preventive strategies for periprosthetic joint infection (PJI) is the use of antibiotic-loaded bone cement (ALBC) in primary total joint arthroplasty (TJA). Even though it is widely used, there are concerns about the development of antibacterial resistance. The aim of the study was to investigate whether using ALBC in primary TJA increases the antibiotic-resistant PJI. The hypothesis was that the regular use of ALBC does not increase the rate of resistant PJI. Methods Patients with confirmed PJI who had revision surgery from year 2010 to 2019 were included in this international multicenter study. The ALBC group was compared to the non-ALBC TJA group from the same time period. Medical records were used to collect clinical (age, gender, body mass index, comorbidities), TJA-related (type of operation, implant type and survival) and PJI-related (cultured microorganism, antibiogram) data. Resistance to gentamicin, clindamycin and vancomycin were recorded from the antibiograms. Multiple logistic regression model was used to identify risk factors and account for the potential confounders. Results 218 patients with PJI were included in the study: 142 with gentamicin-loaded bone cement and 76 in the non-ALBC group. The average age in the ALBC group was 71 ± 10 years and 62 ± 12 years in the comparison group (p < 0.001). Coagulase negative Staphylococci (CONS) were the most common (49%) isolated pathogens. The use of ALBC did not increase the rate of any resistant bacteria significantly (OR = 0.79 (0.42–1.48), p = 0.469). The presence of CONS was associated with higher risk of antibiotic resistance. Conclusions The current study demonstrates no increase in antibiotic resistance due to ALBC after primary TJA. Thus, the use of ALBC during primary TJA should not be feared in the context of antimicrobial resistance. Level of evidence III.

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Antibiotic-Loaded Bone Cement and Periprosthetic Joint Infection

Journal of Long-Term Effects of Medical Implants ◽

10.1615/jlongtermeffmedimplants.2013010238 ◽

2014 ◽

Vol 24 (2-3) ◽

pp. 89-97 ◽

Cited By ~ 29

Author(s):

Antonia F. Chen ◽

Javad Parvizi

Keyword(s):

Bone Cement ◽

Periprosthetic Joint Infection ◽

Joint Infection

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Practical Truth

10.1093/oso/9780198817277.003.0009 ◽

2018 ◽

Author(s):

David Charles

Keyword(s):

Nicomachean Ethics ◽

Third Way ◽

The Third ◽

Two Component ◽

Major Competitor ◽

Additional Support

This paper concerns Aristotle’s discussion of practical truth in Nicomachean Ethics VI.2.1139a17–b5. The essay falls into five sections. In the first three, I outline two styles of interpretation of Aristotle’s remarks and suggest that one of them (which I call ‘the third way’) gives a better reading than that offered by its major competitor (which I call ‘the two-component’ view). In the fourth I consider some texts in the remainder of NE VI which provide additional support for the third way of reading. In a brief concluding section, I seek to locate Aristotle’s view of practical truth, so understood, in a broader philosophical context.

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