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Chen CY, Lin CP, Tsai CH, Chen HY, Chen HT, Lin TL. Medullary-Sparing Antibiotic Cement Articulating Spacer Reduces the Rate of Mechanical Complications in Advanced Septic Hip Arthritis: A Retrospective Cohort Study. J Pers Med 2024; 14:162. [PMID: 38392594 PMCID: PMC10890418 DOI: 10.3390/jpm14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/06/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Antibiotic cement articulating spacers eradicate infection during a two-stage revision for advanced septic hip arthritis (ASHA); however, mechanical complications have been reported. We hypothesized that the rate of mechanical complications would be lower in medullary-sparing (MS) than in non-medullary-sparing (n-MS) articulating spacers. A retrospective study of ASHA using n-MS or MS spacers was conducted between 1999 and 2019. The rate of mechanical complications and reoperation and risk factors for mechanical complications were analyzed. The cohort included 71 n-MS and 36 MS spacers. All patients were followed up for 2 years. The rate of spacer dislocation was lower in MS (0%) than in n-MS spacers (14.1%; p = 0.014). The reoperation rate for mechanical complications was lower in MS (0%) than in n-MS spacers (12.7%; p = 0.019). The rate of a diaphyseal stem during reimplantation was lower in MS (0%) than in n-MS spacers (19.4%; p = 0.002). The identified risk factors for n-MS spacer dislocation were postoperative under-restored femoral head diameter ≥3 mm, femoral offset ≥3 mm, and surgical volume (≤6 resection arthroplasties per year). Both spacers controlled infection. However, MS spacers had a lower spacer dislocation and reoperation rate and avoided the diaphyseal stem during reimplantation. We recommend using MS spacers to restore native femoral head diameter and femoral offset when ASHA is treated by surgeons with lower surgical volumes.
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Affiliation(s)
- Chun-Yen Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chin-Ping Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Hui-Yi Chen
- Department of Radiology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
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Branco RT, Rodrigues EB. Comparison of Surgical Procedures in the Treatment of Hip Periprosthetic Infection. Rev Bras Ortop 2023; 58:e781-e789. [PMID: 37908523 PMCID: PMC10615613 DOI: 10.1055/s-0043-1776132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/05/2023] [Indexed: 11/02/2023] Open
Abstract
Objective The present study aimed to compare the cure rate recovery time and Merle d'Aubigné-Postel functional (MAPF) score after single-stage surgery (C1T) or two-stage surgery (C2T) to treat prosthetic infections of the hip considering sociodemographic and clinical features of the patients. Materials and Methods The present retrospective study occurred in a single center from 2011 to 2014 with 37 studied cases including 26 treated with C1T and 11 with C2T. We compared the cure rate recovery time and MAPF score in the two groups as well as the sociodemographic and clinical features of the patients. We also considered surgical complications and the most common infectious agents. Results The C1T group had a faster functional recovery than the C2T group but there were no significant differences in the cure rate surgical complications or MAPF score. However C1T group patients were significantly younger which may have influenced the outcomes. Staphylococcus spp. was the most common infectious agent (62%). Conclusion Although C2T appears superior regarding infection cure C1T may be preferable for faster functional recovery. However it is critical to consider individual patient characteristics when choosing treatment. Further research with a larger sample size is required to confirm these results.
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Affiliation(s)
- Ricardo Tomé Branco
- Médico ortopedista e Traumatologista, Serviço de Ortopedia e Traumatologia, Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal
| | - Eurico Bandeira Rodrigues
- Médico ortopedista e Traumatologista, Serviço de Ortopedia e Traumatologia, Hospital de Braga, Braga, Portugal
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Adl Amini D, Wu CH, Perka C, Bäcker HC. Cure rate of infections is not an argument for spacer in two-stage revision arthroplasty of the hip. Arch Orthop Trauma Surg 2023; 143:2199-2207. [PMID: 35534712 PMCID: PMC10030410 DOI: 10.1007/s00402-022-04463-9] [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] [Received: 06/26/2021] [Accepted: 04/25/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A devastating complication after total hip arthroplasty (THA) is chronic periprosthetic joint infection (PJI). Most frequently spacers (Sp) with or without antibiotics are implanted in a two-stage procedure even though not always indicated due to unknown pathogen, femoral and acetabular defects or muscular insufficiency. MATERIALS AND METHODS A retrospective analysis of a prospectively collected database was conducted, analyzing the treatment of 44 consecutive cases with chronic PJI undergoing two-stage revision using a Girdlestone situation (GS) in the interim period between 01/2015 and 12/2018. Diagnostics included intraoperative microbiological cultures, histological analysis, sonication of the initial implant, analysis of hip aspiration, as well as laboratory diagnostics and blood cultures. We analyzed the general and age-group-specific success rate of treatment using GS. Furthermore, we compared our data with the current literature on spacer implantation regarding common complications. RESULTS In total, 21 female and 23 male patients at a mean age of 59.3 ± 9.6 years were included. Age groups were divided into young, mid-age, and elderly. In most patients, microbiology revealed Staphylococcus epidermidis in 39.1% of cases, following Staphylococcus lugdunensis and Staphylococcus aureus in 10.9% after THA explantation. For histology, Krenn and Morawietz type 2 (infectious type) was diagnosed in 40.9%, type 3 (infectious and abrade-induced type) in 25.0%. With GS, the total cure rate was 84.1% compared to 90.1% (range 61-100%) using Sp as described in the literature. Among age-groups, cure rate varied between 77.8 and 100%. Other complications, which only occurred in the mid-age and elderly group, included the necessity of transfusion in 31.1%, and in total, one periprosthetic fracture was identified (2.3%). CONCLUSION GS shows an acceptable cure rate at a minimum of 2 years when compared to the cure rate reported in the literature for Sp without major complications. For patients with increased risks for treatment failure using spacer, GS seems to be an alternative for chronic PJI when looking at the success rate of treatment. LEVEL OF EVIDENCE III, Retrospective trial.
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Affiliation(s)
- Dominik Adl Amini
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Chia H Wu
- Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, TX, USA
| | - Carsten Perka
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Henrik C Bäcker
- Department of Orthopedic Surgery and Traumatology, Charité, University Hospital Berlin, Charitéplatz 1, 10117, Berlin, Germany
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FABIO ZANCHINI, CIPOLLONI VALERIO, NASTO LUIGIAURELIO, LUCCHESI SALVATORE, PISCOPO DAVIDE, FUSINI FEDERICO, VITIELLO RAFFAELE, CACCIAPUOTI STEFANO, POLA ENRICO. ACUTE DESTRUCTIVE HIP SEPTIC ARTHRITIS IN A YOUNG ADULT PATIENT: CASE REPORT (v2). Orthop Rev (Pavia) 2022; 14. [DOI: 10.52965/001c.37749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
The Authors describe a case of rapid right hip destructive septic arthritis in a 50-year-old male patient with no previous noteworthy medical history. Patient arrived to our attention following a one week history of right hip pain. Laboratory markers and imaging at presentation were negative. However, on a follow-up examination significant joint effusion was noted and joint tap was performed. Despite wide spectrum antibiotic therapy institution, significant joint damage was observed. This required surgical femoral head excision with antibiotic loaded spacer, followed by hip arthroplasty surgery 12 weeks afterwards. Complete healing of the infection and recovery of pain-free joint motion was noted at 1 year follow-up.
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Affiliation(s)
- ZANCHINI FABIO
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - VALERIO CIPOLLONI
- A. Gemelli IRCCS University Hospital, Catholic University of Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | | | | | - DAVIDE PISCOPO
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - FEDERICO FUSINI
- Regina Montis Regalis Hospital, ASL CN1, Strada S. Rocchetto 99, 12084, Mondovì (CN), Italy
| | | | | | - ENRICO POLA
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
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Fabio Z, Cipolloni V, Nasto LA, Lucchesi S, Piscopo D, Fusini F, Vitiello R, Cacciapuoti S, Pola E. ACUTE DESTRUCTIVE HIP SEPTIC ARTHRITIS IN A YOUNG ADULT PATIENT: CASE REPORT (v2). Orthop Rev (Pavia) 2022; 14:37749. [PMID: 36249180 PMCID: PMC9484038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
The Authors describe a case of rapid right hip destructive septic arthritis in a 50-year-old male patient with no previous noteworthy medical history. Patient arrived to our attention following a one week history of right hip pain. Laboratory markers and imaging at presentation were negative. However, on a follow-up examination significant joint effusion was noted and joint tap was performed. Despite wide spectrum antibiotic therapy institution, significant joint damage was observed. This required surgical femoral head excision with antibiotic loaded spacer, followed by hip arthroplasty surgery 12 weeks afterwards. Complete healing of the infection and recovery of pain-free joint motion was noted at 1 year follow-up.
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Affiliation(s)
- Zanchini Fabio
- Clinical Orthopaedics, Department of Orthopaedics and Traumatology, University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli IRCCS University Hospital, Catholic University of Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Luigi Aurelio Nasto
- Department of Paediatric Orthopaedics, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16147, Genova, Italy
| | - Salvatore Lucchesi
- Italy, Department of Radiology, Catholic University, Rome, Gemelli University Hospital Foundation IRCCS
| | - Davide Piscopo
- Clinical Orthopaedics, Department of Orthopaedics and Traumatology, University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, ASL CN1, Strada S. Rocchetto 99, 12084, Mondovì (CN), Italy
| | - Raffaele Vitiello
- Orthopaedic and Traumatology, Catholic University of the Sacred Heart of Rome
| | - Stefano Cacciapuoti
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento, Italy
| | - Enrico Pola
- Clinical Orthopaedics, Department of Orthopaedics and Traumatology, University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
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Ismat A, Walter N, Baertl S, Mika J, Lang S, Kerschbaum M, Alt V, Rupp M. Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques. J Orthop Traumatol 2021; 22:56. [PMID: 34940945 PMCID: PMC8702599 DOI: 10.1186/s10195-021-00614-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use. Methods A systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible. Results A total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant. Conclusion Adequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted. Level of evidence III.
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Affiliation(s)
- Abdullah Ismat
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Susanne Baertl
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Joerg Mika
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, Klosterlausnitzer Strasse 81, 07607, Eisenberg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Two-stage arthroplasty for septic arthritis of the hip and knee: A systematic review on infection control and clinical functional outcomes. J Clin Orthop Trauma 2021; 24:101720. [PMID: 34926151 PMCID: PMC8649791 DOI: 10.1016/j.jcot.2021.101720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Septic arthritis of the native hip and knee joint poses particular challenges to orthopedic surgeons. Patients often suffer from several comorbidities, and it could be challenging to find a balance between infection control and adequate function. Two-stage arthroplasty has been addressed as a reliable solution, however the literature on the topic is composed of case series with small sample size. This systematic review aimed to analyze data on infection control and clinical functional outcomes of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee. METHODS An electronic search of studies published from January 1st, 2000, to June 1st, 2021, was conducted using eight different databases. Following the Cochrane Handbook of Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Revies and Meta-analysis two authors reviewed the available literature and reference lists to identify papers eligible for inclusion. RESULTS A total of 21 studies were included, involving 435 procedures. The mean age was 57.3 ± 6.2 (45.8-71.8) years. The mean follow-up was 53.7 ± 18.6 (12-86.7) months. The mean infection eradication was 93.3 ± 6.4%. Mean Harris Hip Score improved from 32.1 ± 10.6 (11.5-42.9) to 87.5 ± 5.7 (80.6-97.8). Mean Knee Society Score improved from 42.9 ± 7.6 (35.9-58.0) to 86.1 ± 5.4 (80.1-96.0). CONCLUSIONS Two-stage arthroplasty for hip and knee septic arthritis provided high infection control rate and excellent function. Further high-quality studies should be oriented on providing a validated algorithm for diagnosis and treatment of this condition. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Russo A, Cavagnaro L, Chiarlone F, Clemente A, Romagnoli S, Burastero G. Clinical outcomes and survivorship of two-stage total hip or knee arthroplasty in septic arthritis: a retrospective analysis with a minimum five-year follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:1683-1691. [PMID: 33774699 PMCID: PMC8266791 DOI: 10.1007/s00264-021-05013-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
Purpose Septic arthritis of the native joint is challenging for orthopedic surgeons because it may lead to wide bone defects and severe impairment of joint function. This study aimed to analyze clinical functional outcomes, the rate of infection eradication, and survival of implants of patients who underwent two-stage arthroplasty for septic arthritis of the hip and knee. Methods A retrospective single-centre analysis was conducted of patients treated for septic arthritis of the hip and knee joints through a two-stage surgery between 2012 and 2015. Clinical and radiological records were gathered from the prospectively collected Institutional Arthroplasty Registry. Patients’ pre-operative Harris hip scores and Knee Society scores were compared with those obtained at the latest follow-up. Kaplan–Meier curves were generated to assess survival of implants. Results Forty-seven patients were included. The mean follow-up was 85.2 ± 15.4 months. The Harris hip score improved from 39.4 ± 9.9 to 84.5 ± 10.8 points (p < 0.001). The Knee Society score improved from 40.7 ± 8.4 to 86.0 ± 7.8 points (p < 0.001). Knee Society score-function increased from 25.7 ± 14.2 to 85.4 ± 23.4 points (p < 0.001). The infection eradication rates were 92.0% and 90.9% in patients who underwent hip and knee operation, respectively (p = 0.891). Overall survivorship of implants after the second stage was 93.6%. Conclusions Two-stage arthroplasty provides good to excellent clinical outcomes in cases of active septic arthritis of the hip and the knee, high rates of infection control, and implant survival.
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Affiliation(s)
- Antonio Russo
- Orthopaedic Clinic, Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy.
- Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV 6, 16132, Genoa, Italy.
| | - Luca Cavagnaro
- Joint Arthroplasty Unit, Orthopaedic and Traumatology 2, Santa Corona Hospital, Viale 25 Aprile 38, 17027, Pietra Ligure, Italy
| | - Francesco Chiarlone
- Joint Arthroplasty Unit, Orthopaedic and Traumatology 2, Santa Corona Hospital, Viale 25 Aprile 38, 17027, Pietra Ligure, Italy
| | - Antonio Clemente
- Department of Orthopedics and Traumatology, CTO Hospital, University of Turin, Via G. Zuretti 29, 10126, Turin, Italy
| | - Sergio Romagnoli
- Prosthetic Surgery Centre, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Giorgio Burastero
- Prosthetic Surgery Centre, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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D'Angelo F, Monestier L, Zagra L. Active septic arthritis of the hip in adults: what's new in the treatment? A systematic review. EFORT Open Rev 2021; 6:164-172. [PMID: 33841915 PMCID: PMC8025707 DOI: 10.1302/2058-5241.6.200082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment of bacterial septic arthritis in the native adult hip joint can be challenging. Prompt diagnosis and treatment decisions can reduce the associated morbidity and mortality. For this systematic review of the literature, we asked: (1) What are the treatment options? (2) What are the success rates and the outcomes after treatment? (3) Which antibiotic and duration of therapy are optimal? We searched the electronic databases PubMed, Scopus, and Embase using the search terms “hip” or “native hip” and “septic arthritis” or “coxitis”. Studies were included if they reported on: (1) bacterial infection of the hip, (2) treatment, (3) success rate/outcomes, (4) follow-up. The final review included 19 studies. The quality of study reporting was evaluated with the Methodological Index for Non-randomized Studies (MINORS) questionnaire. Three treatment options are: arthroscopy, single open surgery, and two-stage total hip arthroplasty (THA). A high success rate in infection eradication was reported for all three. Intravenous antibiotic therapy should be promptly initiated to eradicate septic arthritis and minimize potential sequelae and complications. Arthroscopy, single open or two-stage THA were reported to be effective in treating bacterial septic arthritis of the native hip. The key to optimal outcome is early diagnosis and timely treatment.
Cite this article: EFORT Open Rev 2021;6:164-172. DOI: 10.1302/2058-5241.6.200082
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Affiliation(s)
- Fabio D'Angelo
- Division of Orthopaedics and Traumatology, ASST Sette Laghi, Department of Biotechnologies and Life Sciences (DBSV), Università degli Studi dell'Insubria, Varese, Italy
| | - Luca Monestier
- Division of Orthopaedics and Traumatology, ASST Sette Laghi, Varese, Italy
| | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, Hip Department, Milan, Italy
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Sun H, Ma X, Li Z, Liu J, Wang W, Qi X. Release characteristics of enoxaparin sodium-loaded polymethylmethacrylate bone cement. J Orthop Surg Res 2021; 16:108. [PMID: 33541384 PMCID: PMC7860616 DOI: 10.1186/s13018-021-02223-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study aimed to prepare the polymethylmethacrylate (PMMA) bone cement release system with different concentrations of enoxaparin sodium (ES) and to investigate the release characteristics of ES after loading into the PMMA bone cement. METHODS In the experimental group, 40 g Palacos®R PMMA bone cement was loaded with various amount of ES 4000, 8000, 12,000, 16,000, 20,000, and 24,000 AXaIU, respectively. The control group was not loaded with ES. Scanning electron microscopy (SEM) was used to observe the surface microstructure of the bone cement in the two groups. In the experiment group, the mold was extracted continuously with pH7.4 Tris-HCL buffer for 10 days. The extract solution was collected every day and the anti-FXa potency was measured. The experiment design and statistical analysis were conducted using a quantitative response parallel line method. RESULTS Under the SEM, it was observed that ES was filled in the pores of PMMA bone cement polymer structure and released from the pores after extraction. There was a burst effect of the release. The release amount of ES on the first day was 0.415, 0.858, 1.110, 1.564, 1.952, and 2.513, respectively, from the six groups with various ES loading amount of 4000, 8000, 12,000, 16,000, 20,000, and 24,000 AXaIU, all reaching the peak of release on the first day. The release decreased rapidly on the next day and entered the plateau phase on the fourth day. CONCLUSION The prepared ES-PMMA bone cement has high application potential in orthopedic surgery. ES-PMMA bone cement shows good drug release characteristics. The released enoxaparin sodium has a local anti-coagulant effect within 24 h after application, but it will not be released for a long time, which is complementary to postoperative anti-coagulation therapy.
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Affiliation(s)
- Hui Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinzhe Ma
- Department of Orthopaedic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Zhiyong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianning Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangbei Qi
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
- Tiemenguan District of the Third Hospital of Hebei Medical University, Tiemenguan City, China.
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Rava A, Bruzzone M, Cottino U, Enrietti E, Rossi R. Hip Spacers in Two-Stage Revision for Periprosthetic Joint Infection: A Review of Literature. JOINTS 2019; 7:56-63. [PMID: 31879732 PMCID: PMC6930843 DOI: 10.1055/s-0039-1697608] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/06/2019] [Indexed: 02/06/2023]
Abstract
Infection after total hip arthroplasty (THA) is a devastating complication with significant consequences for patients. In literature, single and two-stage revision, irrigation and debridement, Girdlestone resection arthroplasty, and arthrodesis and amputation are reported as possible treatments. Recently, two-stage revision has become popular as the gold standard treatment for chronic hip joint infections after THA. In this review, we evaluate the current literature about microbiology of periprosthetic joint infections and the use of antibiotic-loaded cement spacers. We aim to give an overview about indications, clinical results, and mechanical complications for spacers implantation, evaluating also selection criteria, pharmacokinetic properties, and systemic safety of the most frequently used antibiotics.
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Affiliation(s)
- Alessandro Rava
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Torino, Torino, Italy
| | - Matteo Bruzzone
- SC Ortopedia e Traumatologia, AO Ospedale Mauriziano Umberto I, Torino, Italy
| | - Umberto Cottino
- SC Ortopedia e Traumatologia, AO Ospedale Mauriziano Umberto I, Torino, Italy
| | - Emilio Enrietti
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Torino, Torino, Italy
| | - Roberto Rossi
- SC Ortopedia e Traumatologia, AO Ospedale Mauriziano Umberto I, Torino, Italy
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Xu C, Kuo FC, Kheir M, Li X, Chai W, Chen JY. Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis. BMC Musculoskelet Disord 2019; 20:272. [PMID: 31159792 PMCID: PMC6547501 DOI: 10.1186/s12891-019-2652-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 05/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background The treatment strategy for evolutive septic arthritis (SA) with coexistent degenerative joint disease is not well established. The purposes of this study were to 1) investigate treatment outcome and potential risk factors of treatment failure in patients with evolutive SA following two-stage procedure, including insertion of an antibiotic-loaded spacer at the first stage and subsequent implantation of a new prosthesis; and 2) determine the performance of serum erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Interleukin-6 (IL-6) in predicting persisting infection at second-stage procedure. Methods We retrospectively reviewed 74 patients with evolutive SA of hips and knees who underwent a two-stage TJA between 2008 and 2015. The treatment success was defined according to the modified Delphi criteria and Kaplan-Meier survivorship curves were constructed to determine treatment success. A Cox regression model was performed to identify risk factors for treatment failure. Receiver operating characteristic (ROC) curves were generated to determine the prognostic value of ESR, CRP, and IL-6 in predicting persistent infection before second-stage prostheses implantation. Results Overall, the treatment success rate was 93% for hips and 100% for knees after the first-stage surgery. The treatment success rate was 89% for hips and 84% for knees after second-stage prosthesis implantation with a mean follow-up of 4.7 (range, 2.2 to 10.8) years. Older age (Hazard ratio [HR] [per 10-year increase], 1.20; 95% confidential interval [CI], 1.11 to 1.62), higher preoperative CRP level (HR [per 1-mg/dL increase], 1.15; 95% CI, 1.04 to 1.28) and resistant organism (HR, 13.96; 95% CI, 3.29 to 19.20) were associated with an increased risk of treatment failure. All serologic tests presented limited values in predicting persisting infection, with the area under ROC curve of ESR, CRP, IL-6 and combination of the three markers was 57.8, 61.6, 60.3, and 62.1%, respectively. Conclusions Two-stage TJA is an adequate management of infection control in patients with evolutive SA. The three potential risk factors (old age, high preoperative CRP, and resistant organism profile) may predict treatment failure following a two-stage procedure for evolutive SA. Additionally, serum ESR, CRP, and IL-6 had no benefit in predicting persisting infection before second-stage prostheses implantation. These findings may be useful when treating patients with evolutive SA.
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Affiliation(s)
- Chi Xu
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Matthew Kheir
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Xin Li
- Department of Orthopaedic Surgery, Xingtai People's Hospital, Xingtai, Hebei Provence, China
| | - Wei Chai
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China
| | - Ji-Ying Chen
- Department of Orthopaedic Surgery, General Hospital of People's Liberation Army, No.28 Fuxing Road, Haidian District, Beijing, 100853, China.
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Aalirezaie A, Arumugam SS, Austin M, Bozinovski Z, Cichos KH, Fillingham Y, Ghanem E, Greenky M, Huang W, Jenny JY, Lazarovski P, Lee GC, Manrique J, Manzary M, Oshkukov S, Patel NK, Reyes F, Spangehl M, Vahedi H, Voloshin V. Hip and Knee Section, Prevention, Risk Mitigation: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S271-S278. [PMID: 30348568 DOI: 10.1016/j.arth.2018.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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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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Abstract
INTRODUCTION Total hip arthroplasty (THA) is performed as a 2-stage or single stage procedure in patients with a history of septic arthritis of the native hip joint. The decision is based on whether the infection is active or quiescent in the joint. The aim of this study was to compare the outcomes of total hip arthroplasty for septic arthritis of the native hip to a control series of patients treated for primary osteoarthritis of the hip with standard THA. METHODS Between March 2000 and March 2013, 18 cases of septic arthritis of the hip treated with THA were retrospectively identified. During the same time period, 18 control cases of THA for degenerative osteoarthritis were identified. Cases and controls were comparable in age, gender, body mass index, type of anaesthesia and American Society of Anesthesiologists score. RESULTS 11 and 7 cases received 2-stage and single stage total hip arthroplasty respectively for septic arthritis. There was a mean interval of 4 months between 1st and 2nd-stage operations. Cases and controls were followed up for a mean of 70 and 72 months respectively. There was no reinfection or implant failure in the cases, and comparable functional outcomes between cases and controls. CONCLUSIONS Two-stage and single-stage THA for active and quiescent native hip infection respectively, achieved similar outcomes to THA for primary osteoarthritis in controls.
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Shen H, Wang QJ, Zhang XL, Jiang Y. Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis. Orthopedics 2013; 36:e404-8. [PMID: 23590777 DOI: 10.3928/01477447-20130327-13] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Two-stage total hip arthroplasty (THA) is considered a safe choice for the treatment of primary infectious arthritis of the hip. In cases where the proximal portion of the femur is intact without infection, the use of a spacer with a femoral stem during the interim would disturb the normal femoral medullary cavity. The authors report the technical procedure and outcomes of cases using a novel medullary sparing, antibiotic-loaded hip spacer for the treatment of hip infections.Five consecutive patients (5 hips) with infectious arthritis of the hip were treated in a 2-stage approach using an intraoperatively made medullary-sparing hip spacer. During the first-stage THA, after thorough debridement of potentially infected and necrotic soft tissues, the spacer was inserted into the femoral neck and fixed without opening the femoral canal. Antibiotics were administered for at least 6 weeks and were continued until the infection was controlled clinically, after which the second-stage THA was completed.Infection was eradicated in all 5 hips. Average follow-up was 39.6 months (range, 30-59 months). At most recent follow-up, no recurrence of infection was observed. No specific complications were associated with the use of this novel spacer. Average Harris Hip Score improved from 35.2 (range, 28-43) before the first-stage THA to 61.6 (range, 54-71) between the 2 stages and to 93.6 (range, 89-99) at final follow-up. All patients ambulated with the aid of crutches during the interim period.
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Affiliation(s)
- Hao Shen
- Department of Orthopaedic Surgery, Division of Adult Reconstruction, Shanghai No. 6th Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Republic of China.
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Chang Z, Hou T, Wu X, Luo F, Xing J, Li Z, Chen Q, Yu B, Xu J, Xie Z. An anti-infection tissue-engineered construct delivering vancomycin: its evaluation in a goat model of femur defect. Int J Med Sci 2013; 10:1761-70. [PMID: 24151446 PMCID: PMC3804800 DOI: 10.7150/ijms.6294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 10/06/2013] [Indexed: 12/11/2022] Open
Abstract
A tissue-engineered construct (TEC) has previously been used for treating bone defects due to its strong osteogenic capability. However, transplantation of a TEC involves an open surgery that can cause infection. To overcome the potential risk of infection after TEC transplantation, we designed a system for the controlled release of antibiotics using fibrin gel-coated vancomycin alginate beads (FG-Vanco-AB) that can supply sustained antibiotics at the graft site. A TEC with FG-Vanco-AB was transplanted into critically sized bone defects of the right femur in a goat. As a control, the TEC without FG-Vanco-AB was transplanted into the left femur defect of the same goat. The breakpoint sensitivity of vancomycin for S. aureus (5 mg/L) was used as a known standard. Study results showed that the duration of time with vancomycin concentrations greater than 5 mg/L in the right graft site, blood, and left graft site were 28 days, 7 days, and 2 days, respectively. The bioactivity regarding vancomycin release was analysed by antibiotic disc diffusion. The vancomycin concentration was decreased from the centre of the graft to both ends of the femur. Radionuclide bone imaging showed no significant difference between the right and left TECs at either 28 or 56 days post-operation. Computed tomography and histological observation showed both sides' bone defects were healed by TEC at 112 days post-operation, and there was no significant difference in computed tomography value. These results suggest that FG-Vanco-AB in transplanted bone provided the ability to kill bacteria in local bone tissue while not interfering with the process of bone reconstruction and wound healing.
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Affiliation(s)
- Zhengqi Chang
- 1. National & Regional United Engineering Lab of Tissue Engineering, Department of Orthopaedics, Southwest Hospital, the Third Military Medical University, Chongqing, China. ; 2. Center of Regenetive and Reconstructive Engineering Technology in Chongqing City, Chongqing, China. ; 3. Laboratory of Tissue Engineering in Chongqing City, Chongqing, China. ; 4. Department of Orthopedics, General Hospital of Jinan Military Commanding Region, Jinan, China
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Zhang Y, Qu B, Lun SS, Guo Y, Liu J. The 36-item short form health survey: reliability and validity in Chinese medical students. Int J Med Sci 2012; 9:521-6. [PMID: 22991490 PMCID: PMC3444972 DOI: 10.7150/ijms.4503] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 08/19/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The 36-Item Short Form Health Survey (SF-36) is widely validated and popularly used in assessing the subjective quality of life (QOL) of patients and the general public. The aim of the study is to assess the psychometric properties of the 36-Item Short Form Health Survey (SF-36) in medical students in mainland of China. METHODS The reliability and validity of the 36-Item Short Form Health Survey (SF-36) questionnaire were assessed by conducting a cross-sectional study of Chinese medical students in December 2011. All 1358 3(rd) year and 4(th) year medical students from 46 classes at China Medical University were investigated. RESULTS The overall Cronbach's α coefficient of the SF-36 questionnaire was 0.791, while the respective Cronbach's α coefficients for each of the seven dimensions were > 0.70, except where the social function dimension was 0.631. Results showed that the SF-36 questionnaire was reliable and valid. CONCLUSION In general, this study provides evidence that the SF-36 questionnaire is suitable measures for assess the QOL of medical students in China.
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Affiliation(s)
- Yang Zhang
- The Research Centre for Medical Education, China Medical University, 92 North Second Road, Heping District, Shenyang 110001, China
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Yoshida S, Yokoyama R, Sakamoto A. Treatment of pelvic defect and infection with endoprosthesis exposure by topical negative pressure and irrigation with myocutaneous flap. Microsurgery 2011; 31:655-8. [PMID: 21919051 DOI: 10.1002/micr.20932] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 05/06/2011] [Accepted: 05/16/2011] [Indexed: 01/13/2023]
Abstract
The treatment of wound complications and deep infection after hemipelvectomy is challenging. We describe a 17-year-old woman with Ewing sarcoma in the pelvis who underwent hemipelvectomy and reconstruction with an artificial hip joint and bone cement. After the operation, skin necrosis and deep infection with methicillin-resistant Staphylococcus aureus (MRSA) were observed. Debridement resulted in exposure of the artificial joint and bone cement. Topical negative pressure (TNP) and irrigation successfully eradicated the infection. The skin and soft-tissue defect was subsequently reconstructed using a combination of free latissimus dorsi myocutaneous flap and serratus anterior muscle flap. To our knowledge, this is the first described case of combined TNP and irrigation with myocutaneous flap for the treatment of pelvic infection and skin and soft-tissue defect with endoprosthesis exposure.
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Affiliation(s)
- Sei Yoshida
- Department of Plastic Surgery, National Hospital Organization, Kyushu Cancer Center, Fukuoka, Japan
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Romanò CL, Romanò D, Meani E, Logoluso N, Drago L. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study. BMC Infect Dis 2011; 11:129. [PMID: 21575241 PMCID: PMC3118141 DOI: 10.1186/1471-2334-11-129] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 05/16/2011] [Indexed: 01/31/2023] Open
Abstract
Background Outcome data on two-stage revision surgery for deep infection after septic hip arthritis are limited and inconsistent. This study presents the medium-term results of a new, standardized two-stage arthroplasty with preformed hip spacers and cementless implants in a consecutive series of adult patients with septic arthritis of the hip treated according to a same protocol. Methods Nineteen patients (20 hips) were enrolled in this prospective, non-randomized cohort study between 2000 and 2008. The first stage comprised femoral head resection, debridement, and insertion of a preformed, commercially available, antibiotic-loaded cement hip spacer. After eradication of infection, a cementless total hip arthroplasty was implanted in the second stage. Patients were assessed for infection recurrence, pain (visual analog scale [VAS]) and hip joint function (Harris Hip score). Results The mean time between first diagnosis of infection and revision surgery was 5.8 ± 9.0 months; the average duration of follow up was 56.6 (range, 24 - 104) months; all 20 hips were successfully converted to prosthesis an average 22 ± 5.1 weeks after spacer implantation. Reinfection after total hip joint replacement occurred in 1 patient. The mean VAS pain score improved from 48 (range, 35 - 84) pre-operatively to 18 (range, 0 - 38) prior to spacer removal and to 8 (range, 0 - 15) at the last follow-up assessment after prosthesis implantation. The average Harris Hip score improved from 27.5 before surgery to 61.8 between the two stages to 92.3 at the final follow-up assessment. Conclusions Satisfactory outcomes can be obtained with two-stage revision hip arthroplasty using preformed spacers and cementless implants for prosthetic hip joint infections of various etiologies.
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Affiliation(s)
- Carlo L Romanò
- Dipartimento di Chirurgia Ricostruttiva e delle Infezioni Osteo-articolari Istituto Ortopedico I,R,C,C,S, Galeazzi, Milano, Italy.
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