Improved antibiotic impregnated cement prosthesis for treating deep hip infection: a novel design using hip compression screw

Quality of life after staged revision for infected total hip arthroplasty: a systematic review

INTRODUCTION

The aim of this review was to assess (health-related) quality of life ([HR]Qol) after 1-stage or 2-stage revision for prosthetic joint infection of the hip (PJI). Additionally, we compared (HR)QoL scores with normative population scores to assess whether QoL is reduced after revision for PJI.

METHODS

A systematic search was performed in Embase, Cochrane and Pubmed. We included articles that reported (HR)QoL questionnaires after staged revision for hip PJI with a minimum follow-up of 24 months. Methodological quality was assessed using the MINORS score.

RESULTS

The search produced 11,195 results. We selected 12 papers describing 2-stage revisions. The mean MINORS score was 9.8. Average WOMAC scores of 185 patients with a mean follow-up of 69.8 months were 73.Average Short Form 36 (SF-36) scores of 159 patients with a mean follow-up of 40.7 months were 40.4 for the physical component score (PCS) and 51.6 for the mental component score (MCS). Average Short Form 12 (SF-12) scores of 154 patients with a mean follow-up of 73.4 months were: a PCS of 35.4 and a MCS of 49.1. The WOMAC, SF-12 (PCS) and SF-36 (PCS) were respectively 12%, 26.7% and 14.8% lower, compared to normative values.

DISCUSSIONS

Patients who underwent 2-stage revision for hip PJI had substantially lower (physical component) (HR)QoL scores, but mental scores were comparable to the general population.

Are Preformed Articulating Spacers Superior To Surgeon-Made Articulating Spacers in the Treatment Of PJI in THA? A Literature Review

Background and Purpose:

Antibiotic-loaded cement spacers are typically manufactured by surgeons in the operating room. However, if the infecting organism is known preoperatively, the cement spacer can be fabricated (Spacer-G^® or the InterSpace^® Hip) in advance. It is unclear if preformed hip spacers are superior to surgeon-made hip spacers in the treatment of periprosthetic joint infection following primary THA.

Methods:

A literature review of the peer-reviewed literature indexed by MEDLINE and Embase was performed to identify studies reporting the outcomes of preformed and surgeon-made hip spacers in the treatment of infection following primary total hip arthroplasty (THA). A total of 43 articles met the inclusion criteria and were included in the analysis to compare the reinfection rate, Harris Hip Score (HHS) and spacer complication rates between surgeon-made and preformed hip spacers.

Results and Interpretation:

The analyzed studies included a total number of 1631 infected THA cases (n=1027 surgeonmade; n=604 preformed spacers). We found similar reinfection rates (6.0% surgeon-made, and 5.5% preformed spacers) and similar mean HHS at latest follow-up after reimplantation (HHS=84.3 surgeon-made, and HHS=81.8 preformed spacers) between both groups. However, patients treated with a surgeon-made articulating spacer had a higher spacer fracture rate compared to preformed articulating spacer. The use of preformed articulating spacers in the treatment of infected THA is not superior to surgeon-made articulating spacers regarding infection control and functional outcomes. However, the use of surgeon-made antibiotic spacers increased the risk of spacer fracture.

Management of total femoral bone loss using a hybrid cement spacer surgical technique

Standard treatment for an infected total hip arthroplasty is 2-stage revision. Bone loss in infected total hip arthroplasty presents specific challenges during the first stage. This is especially the case when there is massive or complete loss of the femoral bone stock. We describe a technique successfully used in the setting of total femoral bone loss using a hybrid cement spacer. We describe 2 cases illustrating the technique and perioperative course. This technique is a potential solution for total femoral bone loss that allows the individual to maintain mobility before definitive surgery.

Increasing the elution of vancomycin from high-dose antibiotic-loaded bone cement: a novel preparation technique

BACKGROUND

Antibiotic bone cement is commonly used in staged revision arthroplasty as well as the treatment of open fractures. Multiple factors affect antibiotic elution from bone cement. This study was performed to investigate the effect of two variables, the quantity of liquid monomer and the timing of antibiotic addition, on the ultimate elution of antibiotic from bone cement.

METHODS

Vancomycin-loaded Simplex P and SmartSet MV bone cement was prepared with three different methods: a common surgical technique, a mixing technique that doubled the amount of liquid monomer, and a novel technique that delayed antibiotic addition until after thirty seconds of polymerization. Cylinders of a standardized size were created from each preparation. The elution profiles of five cylinders from each preparation were measured over six weeks with use of high-performance liquid chromatography. Cylinders were tested in compression to quantify strength.

RESULTS

Delayed antibiotic addition resulted in significantly greater cumulative elution over six weeks (p < 0.0001), with minimal reduction in strength, compared with the other groups. Doubling the liquid monomer significantly reduced cumulative elution over six weeks compared with either of the other techniques (p < 0.0001). Vancomycin elution from Simplex P was 52%greater and vancomycin elution from SmartSet MV was 25% greater in the delayed-antibiotic-addition groups than it was in the corresponding standard surgical technique groups. The majority of the antibiotic was released over the first week in all groups. : High-dose-antibiotic bone cement prepared with delayed antibiotic addition increased vancomycin elution compared with the standard surgical preparation. Incorporating additional liquid monomer decreased vancomycin elution from high-dose-antibiotic cement. We recommend preparing high-dose-antibiotic bone cement with the delayed-antibiotic addition technique and not incorporating additional liquid monomer.

CLINICAL RELEVANCE

Both the relative volume of liquid monomer and the timing of antibiotic addition have substantial effects on the elution of antibiotic from bone cement.

The effect of endoskeleton on antibiotic impregnated cement spacer for treating deep hip infection

Backgrounds

A two-stage revision arthroplasty was suggested optimal treatment for deep infections in hip joint. The effect of endoskeleton of cement spacers on the interim function and infection control remains unclear.

Methods

From Jan. 2004 to Dec. 2007, we collected a prospective cohort of consecutive 34 patients who treated with two-stage revision total hip arthroplasty for deep infection of hip joint. In group 1, fifteen patients were treated by a novel design augmented with hip compression screw while nineteen patients were treated by traditional design in group 2.

Results

No fracture of cement spacer occurred in group 1 while 6 cases developed spacer failure in group 2. (p < 0.05) There were significant differences in bodily pain and general health perception between groups (p < 0.05).

Conclusions

Patients being treated for deep infection of hip joint using cement spacer augmented with stronger endoskeleton have lower pain levels and better joint function between stages.