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Zhang H, Zheng S, Liu Q, Wei P, Gu F, Yu J, Wang Z, Li J, Xu Y, Tang C, Yao Q, Du C, Wang L. 3D-printed antibiotic-loaded bone cement spacers as adjunctive therapy for hip periprosthetic infection after arthroplasty: A clinical assessment. Int J Antimicrob Agents 2024; 63:107080. [PMID: 38163551 DOI: 10.1016/j.ijantimicag.2023.107080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE To explore the effect of three-dimensional (3D) printing to create personalized antibiotic-loaded bone cement (ALBC) spacers to assist in treatment of periprosthetic infection after total hip arthroplasty (THA). METHODS The data of 40 patients with postoperative infection after THA were analysed retrospectively. The patients were divided into two groups: the 3D-printing group (age 47-78 years, n = 20) and the conventional group (age 57-78 years, n = 20). In stage I surgery, 3D-printed silicone moulds were used to create ALBC spacers for the 3D-printing group, while traditional manual methods were used to create spacers for the conventional group. After the infection was controlled, both groups underwent conventional hip revision surgery (stage II surgery). All patients were evaluated using the Harris Hip Score (HHS) (primary outcome) for hip function. RESULTS All 40 patients had follow-up data from 3 months after stage I surgery and 12 months after stage II surgery. The intergroup difference in HHS was 11.25 points [97.5% confidence interval (CI) 7.92-14.58; P < 0.01] at 3 months after stage I surgery, and 9.15 points (97.5% CI 4.82-13.48; P < 0.01) at 12 months after stage II surgery. The overall difference between the two groups was 9.55 points (97.5% CI 5.83-13.27; P < 0.01), which was significant (P < 0.05). CONCLUSION During the follow-up period, the hip function of the 3D-printing group was superior to that of the conventional group following the treatment of infections after THA.
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Affiliation(s)
- Huikang Zhang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China; Nanjing Clinical Nuclear Medicine Centre, Nanjing, Jiangsu Province, China
| | - Suyang Zheng
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qingbai Liu
- Department of Orthopaedics, Lianshui People's Hospital of Kangda College Affiliated to Nanjing Medical University, Huai'an, Jiangsu Province, China; Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Peiran Wei
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Fei Gu
- Department of Orthopaedics, The Second People's Hospital of Lianyungang, Lianyungang, Jiangsu Province, China
| | - Jiangping Yu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China; Nanjing Clinical Nuclear Medicine Centre, Nanjing, Jiangsu Province, China
| | - Zizheng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Nanjing Clinical Nuclear Medicine Centre, Nanjing, Jiangsu Province, China
| | - Jiayi Li
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Yan Xu
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Cheng Tang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Qingqiang Yao
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China.
| | - Chuanlin Du
- Department of Orthopaedics, The Ganyu District People's Hospital of Lianyungang City, Lianyungang, Jiangsu, China.
| | - Liming Wang
- Department of Orthopaedics, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China; Institute of Digital Medicine, Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Vicente M, Vilar I, Soriano RF, Capó I, Corona PS. Two-stage strategy in end-stage hip periprosthetic joint infection: utility of industrially prefabricated custom-made antibiotic spacers. Hip Int 2022:11207000221075356. [PMID: 35438009 DOI: 10.1177/11207000221075356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Use of prefabricated mobile spacers in end-stage cases of hip periprosthetic joint infection (HPJI) is hindered when large bone defects exist. In such cases, prefabricated custom-made antibiotic spacers (P-CMAS) offer an alternative. Such spacers are individually designed according to the size and anatomical characteristics of the bone defect. The purpose of this study is to describe and evaluate the use of such patient-specific spacers in a two-stage strategy to treat end-stage HPJI cases, and to report on clinical outcomes. METHODS A retrospective study identified all patients with end-stage HPJIs from January 2015 through December 2019, treated using a P-CMAS. Primary outcome: infection eradication rate. Secondary outcomes: spacer-related complications and patient satisfaction. Minimum follow-up: 12 months after the second-stage surgery. RESULTS A total of 7 end-stage cases (mean of 6.7 previous surgical procedures) were included. Mean bone defect size was 191.57 (range 47-304) mm. Polymicrobial infection was detected in 42.86% of these cases. During the spacer stage there were no periprosthetic fractures, spacer dislocations or breakages, nor spacer-drug-related complications. All patients proceeded with the second stage uneventfully, with an average time between stages of 178 (range 119-326) days. In 5 cases a total femur arthroplasty was the reconstructive procedure performed. After a mean follow-up of 27.29 (range 14-49) months the infection was clinically eradicated in all patients, despite their difficult-to-treat scenarios. CONCLUSIONS Industrially custom-made spacers offer an effective and safe option in performing 2-stage exchange arthroplasty in cases of end-stage HPJI with extensive bone defects.
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Affiliation(s)
- Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Inca Vilar
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Rosa Fraile Soriano
- Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Surgical nurse team, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Spain
| | - Irina Capó
- Orthopaedic Surgery Department, Francesc de Borja Hospital, Gandía, Spain
| | - Pablo S Corona
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain.,Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
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Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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Anagnostakos K, Fink B. Antibiotic-loaded cement spacers – lessons learned from the past 20 years. Expert Rev Med Devices 2018; 15:231-245. [DOI: 10.1080/17434440.2018.1435270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Bernd Fink
- Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Germany
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Flores X, Vicente M, Haddad S, Amat C, Carrera L, Corona P. “Reverse” hip spacer for massive distal femur defects in peri-prosthetic knee infections. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016. [DOI: 10.1016/j.recote.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Flores X, Vicente M, Haddad S, Amat C, Carrera L, Corona P. Espaciador de cadera «invertido» para defectos masivos de fémur distal en infecciones periprotésicas de rodilla. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:346-354. [DOI: 10.1016/j.recot.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/07/2016] [Accepted: 06/25/2016] [Indexed: 12/19/2022] Open
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Bori G, García-Oltra E, Soriano A, Rios J, Gallart X, Garcia S. Dislocation of preformed antibiotic-loaded cement spacers (Spacer-G): etiological factors and clinical prognosis. J Arthroplasty 2014; 29:883-8. [PMID: 24269066 DOI: 10.1016/j.arth.2013.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/20/2013] [Accepted: 10/14/2013] [Indexed: 02/01/2023] Open
Abstract
This study assesses the factors associated with the dislocation of the Spacer-G and its clinical prognosis. Seventy-four spacers were reviewed. Acetabular bone defects, proximal femoral cementation of the spacer and its relationship to the size of the head spacer were not associated with dislocation. The only variable that it was possible to associate with dislocation was when the previous stem, prior to the spacer placement, was a cemented stem. In patients who experienced a dislocation, infection was not cured during the interim period more frequently than patients who had not experienced a dislocation (P = 0.001) and the final clinical hip evaluation was also worse (P < 0.001). The study concludes that the surgeon should assess different surgical aspects in order to avoid mechanical complications such as dislocation and its consequences.
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Affiliation(s)
- Guillem Bori
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ester García-Oltra
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - José Rios
- Laboratory of Biostatistics and Epidemiology, Autonomus University of Barcelona, Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Xavier Gallart
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sebastian Garcia
- Department of Orthopaedic Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain
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Corona PS, Barro V, Mendez M, Cáceres E, Flores X. Industrially prefabricated cement spacers: do vancomycin- and gentamicin-impregnated spacers offer any advantage? Clin Orthop Relat Res 2014; 472:923-32. [PMID: 24142302 PMCID: PMC3916603 DOI: 10.1007/s11999-013-3342-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/09/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known. QUESTIONS/PURPOSES We therefore sought to compare industrially prefabricated spacers containing either gentamicin or gentamicin and vancomycin with respect to (1) infection control, (2) complications, and (3) quality of life, pain, and patient satisfaction. METHODS We performed a review of 51 patients with chronic infections treated at one center using either gentamicin or vancomycin and gentamicin-prefabricated spacers. The former were used exclusively from January 2006 until May 2009, and the latter from June 2009 until July 2011, and there was no overlap. We collected data on demographics, immunologic status (McPherson classification), prosthetic joint infection location, type of prosthesis, microbiologic results, and time between stages. We evaluated the primary outcome of infection control or recurrence after at least 12 months followup. We also recorded complications. Each patient completed a quality-of-life survey, VAS, and a self-administered satisfaction scale. RESULTS The overall infection control rate was 83% after a mean followup of 35 months (range, 12.4-64.7 months). There were no differences between gentamicin and vancomycin and gentamicin spacers in terms of infection eradication (80 % versus 85 %, respectively; p = 0.73), nor in terms of complications, quality of life, pain, or satisfaction scores. CONCLUSIONS Prefabricated, antibiotic-loaded cement spacers has been proven effective for infection control in TKAs and THAs but with the numbers available, we did not find any differences between a gentamicin or vancomycin and gentamicin-prefabricated spacer, and therefore, we are unable to validate the superiority of the combination of vancomycin and gentamicin over gentamicin alone. Because of the higher costs involved with vancomycin and gentamicin spacers, and the potential risks of unselective use of vancomycin, further comparative studies are necessary to evaluate their role in the treatment of infected THAs or TKAs. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Pablo S. Corona
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Reconstruction and Septic Surgery Division, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Department of Orthopaedic Surgery, Hospital de Traumatología y Rehabilitación Vall d′Hebron, Passeig Vall d′Hebron 119-129, 08035 Barcelona, Spain
| | - Victor Barro
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Marye Mendez
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Enric Cáceres
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Xavier Flores
- Department of Orthopaedic Surgery, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain ,Reconstruction and Septic Surgery Division, Hospital Universitario Vall d′Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
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Citak M, Argenson JN, Masri B, Kendoff D, Springer B, Alt V, Baldini A, Cui Q, Deirmengian GK, Del Sel H, Harrer MF, Israelite CL, Jahoda D, Jutte PC, Levicoff E, Meani E, Motta F, Pena OR, Ranawat AS, Safir O, Squire MW, Taunton MJ, Vogely CH, Wellman SS. Spacers. J Arthroplasty 2014; 29:93-9. [PMID: 24342279 DOI: 10.1016/j.arth.2013.09.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Citak M, Argenson JN, Masri B, Kendoff D, Springer B, Alt V, Baldini A, Cui Q, Deirmengian GK, del Sel H, Harrer MF, Israelite C, Jahoda D, Jutte PC, Levicoff E, Meani E, Motta F, Pena OR, Ranawat AS, Safir O, Squire MW, Taunton MJ, Vogely C, Wellman SS. Spacers. J Orthop Res 2014; 32 Suppl 1:S120-9. [PMID: 24464885 DOI: 10.1002/jor.22555] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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