Are Cement Spacers and Beads Loaded with the Correct Antibiotic(s) at the Site of Periprosthetic Hip and Knee Joint Infections?

Konstantinos Anagnostakos,Ismail Sahan

doi:10.3390/antibiotics10020143

Abstract

The optimal impregnation of antibiotic-loaded bone cement in the treatment of periprosthetic hip and knee joint infection is unknown. It is also unclear, whether a suboptimal impregnation might be associated with a higher persistence of infection. A total of 93 patients (44 knee, 49 hip) were retrospectively evaluated, and the most common organism was a methicillin-resistant Staphylococcus epidermidis, followed by methicillin-susceptible Staphylococcus aureus. Of all the organisms, 37.1% were resistant against gentamicin and 54.2% against clindamycin. All organisms were susceptible against vancomycin. In 41 cases, gentamicin-loaded beads were inserted and in 52 cases, spacers: (2 loaded only with gentamicin, 18 with gentamicin + vancomycin, 19 with gentamicin + clindamycin, and 13 with gentamicin + vancomycin + clindamycin). The analysis of each antibiotic impregnation showed that complete susceptibility was present in 38.7% of the cases and partial susceptibility in 28%. In the remaining 33.3%, no precise statement can be made because either there was a culture-negative infection or the antibiotic(s) were not tested against the specific organism. At a mean follow-up of 27.9 months, treatment failure was observed in 6.7% of the cases. Independent of which antibiotic impregnation was used, when the organism was susceptible against the locally inserted antibiotics or not tested, reinfection or persistence of infection was observed in the great majority of cases. Future studies about the investigation of the optimal impregnation of antibiotic-loaded bone cement are welcome.

Highlights

Periprosthetic hip and knee joint infections (PJI) pose a rare but hazardous complication
With regard to the local antibiotic therapy, antibiotic-loaded acrylic bone cement (ALAC) is established to be a valuable device no prospective study has yet demonstrated its efficacy over systemic antibiotics alone [5]
All patients, who were treated in our department between 2016 and 2020 with a twostage exchange arthroplasty at the site of late periprosthetic hip and knee joint infections, were regarded to be potential candidates for inclusion in the study

Summary

Introduction

Periprosthetic hip and knee joint infections (PJI) pose a rare but hazardous complication. Independent of which surgical strategy is applied, it is universally accepted that the success of each procedure is based on three columns: the surgical debridement of all infected, necrotic and ischemic tissue including removal of all affected prosthetic components; as well as local and systemic antibiotic therapy. With regard to the local antibiotic therapy, antibiotic-loaded acrylic bone cement (ALAC) is established to be a valuable device no prospective study has yet demonstrated its efficacy over systemic antibiotics alone [5]. Either in the form of beads or spacers, ALAC provides high local antibiotic concentrations during the postoperative period, which vastly exceeds those after systemic administration, and has low or no systemic side effects [1]. Literature data show that in most cases ALAC is impregnated with a combination of an aminoglycoside and a glycopeptide because it produces a broader antimicrobial spectrum and has a synergistic effect on their pharmacokinetic properties [1]

Methods

Discussion

Conclusion