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

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.

A Systematic Review and Meta-Analysis of Combined Antibiotic Spacer with Ilizarov Methods in the Treatment of Infected Nonunion of Tibia

Background. The objective of this systematic review was to evaluate current studies available reporting the antibiotic spacer combined with Ilizarov methods in the treatment of infected nonunion of tibia and to perform meta-analysis of bone results and infection recurrence to assess the efficacy of an antibiotic spacer combined with Ilizarov methods. Methods. The MEDLINE, Embase, Cochrane Library, CNKI, and CBM (Chinese Biological Medicine) databases were searched for articles published between January 2000 and July 2020. Assessment of study quality was performed using a modified version of the Newcastle-Ottawa scale. Effect size and 95% confidence intervals were calculated for the main outcome. Heterogeneity was assessed. Fixed-effect modeling and Stata version 15.1 were used to analyze the data. Sensitivity analyses were conducted with the evidence of heterogeneity. Results. 11 studies involving 210 patients with infected nonunion of tibia were finally included in our meta-analysis. Bone results and infection recurrence were analyzed based on the single-arm meta-analysis. The average of external fixation index (EFI) was 46.88 days/cm in all studies included. The excellent rate in bone results and the rate of infection recurrence was 65% (95% CI: [0.22, 0.97], I 2 = 0.0 % , P = 0.932 ) and 6.99% (95% CI: [0.052, 0.325], I 2 = 0.0 % , P = 1.000 ) in patients with infected nonunion of tibia treated with an antibiotic spacer combined with Ilizarov methods. Conclusions. Our meta-analysis revealed that the patients with infected nonunion of tibia treated with an antibiotic spacer combined with Ilizarov methods had a high rate of excellent bone results and a low rate of infection recurrence. Therefore, combining the antibiotic spacer with Ilizarov methods may be an applicable choice for repairing and reconstructing infected nonunion of tibia.

Augmentation of Internal Fixation With Multiplanar External Fixator in High Risk Hind Foot Fusion Patients

Category: Hindfoot; Ankle; Diabetes Introduction/Purpose: Achieving adequate fixation is a critical component for successful fusion. Internal fixation can be compromised in the setting of poor bone quality due to open trauma, infection, osteoporosis, neuropathic arthropathy resulting in published ankle non-union rates of 38% in high risk patients. These failures may be magnified by weightbearing non-compliance. While the use of multiplanar external fixation (MEF) alone can be utilized - it can often require an extended period of time within the frame (mean 18 weeks, range 9-28 weeks) and complications such as pin site infections. We hypothesized that hybrid fixation, MEF in conjunction with internal fixation, will provide adequate stability elevating the fusion rates in complex fusion cases while allowing early weight bearing and reduces the MEF time and infection rate. Methods: Eleven patients were identified that demonstrate significant risk factors for a successful fusion (infection, charcot, neuropathy, smoking, history of non-union) that were treated with internal fixation augmented with MEF. Patients with an active infection underwent surgical irrigation and debridement, placement of an antibiotic spacer and a course of intravenous antibiotics six weeks prior to placement of internal fixation. In these cases, MEF was placed at the time of surgical irrigation and debridement to allow for stability. In those patient’s without an active fixation, both the internal fixation and MEF were placed at the same time. Internal fixation construct was based on surgeon preference. Patients were allowed to transfer weight bear at the time of surgery and could advance as tolerated after 2 weeks. CT was utilized to assess fusion. Outcomes measured were fusion rate and occurrence of internal fixation infection. Results: The mean age of patients was 55 (range 26-75), eight patients had diabetes, three were current smokers, two were former smokers, two patients had open trauma, one patient had peripheral neuropathy and one patient had a history of a non- union with known non-compliance. Six patients had an active infection and underwent irrigation and debridement, placement of antibiotic spacer and MEF during antibiotic treatment. Seven patients underwent intramedullary nail fixation, three patients underwent plate and screw constructs and one patient underwent screw only fixation. CT demonstrated fusion in all patients (100%). The mean time for external fixation was 72 days (range 41-111). There were no cases of infected internal fixation. Conclusion: The findings of the current study suggest high rates of hind foot fusion with the use of internal fixation augmented with MEF in a complex patient group with identified high non-union risk factors. Using internal fixation, patients time in the frame is much reduced than published studies evaluating MEF alone for fusion fixation. MEF did not result in any cases of infected internal fixation. Patients with hybrid fixation also benefit from early weight bearing. We emphasize the importance of good surgical technique and infection management using this technique.