Antibiotic-impregnated Cement Research Articles

The use of triple antibiotic prophylaxis during total knee replacement surgeries in Awka, Nigeria

Introduction: Total knee arthroplasty periprosthetic joint infection (PJI) poses a significant challenge in orthopaedic surgery, often resulting in early failure and associated with high morbidity and mortality rates. Various treatment strategies exist, including debridement, antibiotic therapy, and prosthesis retention, with preventive measures such as antibiotic-impregnated cement and prophylactic antibiotics administration recommended by the American Academy of Orthopaedic Surgeons (AAOS). Methodology: This prospective cohort study was conducted in an orthopaedic hospital in Awka, Southeast Nigeria, spanning seven years (2014-2021). A total of 134 patients who underwent primary and revision knee arthroplasty were included. The hospital's antibiotic prophylaxis protocol for implant surgeries, including arthroplasties, involved a triple combination of ceftriaxone, ciprofloxacin, and metronidazole administered pre-, intra-, and postoperatively for a minimum of 7 days. Results: The study population had a mean age of 63.6 years, predominantly female (77.7%), and of Christian faith (100%). Most participants were of Igbo ethnicity (99.3%), married (90.7%), and engaged in business (37.7%). Severe osteoarthritis was the primary diagnosis in 97.0% of cases, while rheumatoid arthritis accounted for 3.0%. The triple antibiotic prophylaxis regimen resulted in only one case of superficial infection, with no instances of deep infection recorded. Conclusion: Triple antibiotics prophylaxis, comprising ceftriaxone, ciprofloxacin, and metronidazole, demonstrated effectiveness in preventing infections associated with total knee arthroplasty. This regimen maintained surgical site infection prevalence within acceptable limits for clean surgeries, without observable antibiotic resistance in the study population.

Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk.

To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. Retrospective cohort. Academic medical center. Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

MANAGEMENT OF A PERIPROSTHETIC INFECTION AFTER TOTAL LEFT KNEE REPLACEMENT USING AN ORIGINAL METHOD FOR ARTICULATING SPACER MANUFACTURING: CASE STUDY

Periprosthetic infection (PPI) is one of the most severe complications after total knee replacement. While managing patients with chronic deep PPI after total knee replacement, two-stage revision arthroplasty with intermediate installation of an antimicrobial knee joint spacer is used. The advantage of an articulating spacer is the ability to maintain motor activity until reimplantation of a permanent endoprosthesis. However, factory moulds including 3D-printed are not always available in routine clinical practice, given the high cost and limited equipment accessibility.&#x0D; We present a case study of a patient with chronic deep PPI after total left knee replacement. An original method of intraoperative manufacturing of the tibial component of the articulating spacer was used in the course of treatment. The technique involves sterile mould making using a fitting plastic liner and soft polymer mass. Bone cement impregnated with antibacterial drugs is placed into the mould. When the bone cement hardens, a tibial spacer component is ready. The sterilized femoral and fabricated tibial spacer components are implanted using antibiotic-impregnated bone cement. If it is not technically possible to use fitting inserts, a previously removed plastic insert from the endoprosthesis can be used. The developed original method has a number of advantages: individual selection of spacer sizes, independent addition of the required quantity and type of antibacterial drugs, and economic efficiency. Successful infection relief in the patient allowed further revision endoprosthetics with installation of a permanent endoprosthesis.

Utilizing an antibiotic-eluting articulated cemented spacer in the two-stage management of infected total hip arthroplasty: a technical note.

Two-stage revision is generally preferred to eradicate chronic periprosthetic infections after total hip arthroplasty (THA) because of its good infection control and promising results. During two-stage revision, a temporary antibiotic-impregnated cement spacer was initially used for the local delivery of antibiotics, thereby reducing the risk of infection recurrence. Many researchers have reported various techniques for fabricating cemented spacers; however, there is no established standard technique. We share our cost-effective and easily reproducible technique for creating an articulated cemented spacer for managing infected THA.

Addition of Antibiotic-Impregnated Bone Cement Discs for Reduction of Periprosthetic Infection in Implant-Based Breast Reconstruction

Addition of Antibiotic-Impregnated Bone Cement Discs for Reduction of Periprosthetic Infection in Implant-Based Breast Reconstruction

Antibiotic Impregnated Cement Coated Intramedullary Nailing in the Management of Infected Fractures and Chronic Osteomyelitis of Long Bones

Background: In the era of modern transportation there is an increased incidence of compound fractures especially of long bones. As the skin barrier is broken, the bacteria from dirt, other contaminants can colonize at the wound site and thus can cause infection. Healing at the fracture site and that of soft tissues can be severely compromised by infection. So, treating the infection first followed by definitive fixation of fracture will nearly take 4-6 weeks. The antibiotic nailing technique can thus achieve both the targets in a short time. Local delivery of drug controls the infection and the fixation achieves stability. This even reduces the side effects due to over use of systemic and oral antibiotics. Osteomyelitis is also very common which can be hematogenous or post traumatic. This can weaken the bone and can cause fractures with trivial trauma. Discharging sinuses may also be accompanying. So even in this scenario long term use of antibiotics systemically may be required causing side effects. Antibiotic nailing can be very useful in this scenario. Methods: This is a prospective observational study. 20 patients above age of 20 years who were admitted or on follow up during the period of 2 years were considered for study. The patients with infected fractures with or without implant in situ and patients with chronic osteomyelitis with discharging sinuses were included. ASAMI Criteria: The final outcome is graded based on ASAMI criteria proposed by Paley et al. This was usually developed for determining the outcome after treatment of nonunion with Ilizarov ring fixator. It was applied in our study with some modification. Results: The average duration for achieving bony union was around 5 months (20 weeks). Minimum duration for bony union was around 4 months (16 weeks). Maximum duration for bony union was around 7 months (28 weeks) Average duration for control of infection in case of chronic osteomyelitis was around 4 months. Minimum duration for control of symptoms was 5 months. Maximum duration for control of symptoms was 7 months. Conclusion: Antibiotic impregnated cement coated intramedullary nailing is a very good and effective treatment for infected nonunion and chronic osteomyelitis long bones with bone defect less than 2 cm. In case of infected nonunion, as the bone ends will be sclerosed, freshening of ends and bone grafting is needed.

Combining non-vascularized fibula and cancellous graft in the masquelet technique: A promising approach to distal femur compound fracture management with large defects

IntroductionCompound fractures of the distal femur with large defects pose a significant challenge in management, with several options available, including external fixators, bone grafting, the Masquelet-induced membrane technique, and free vascularized fibular grafts. The Masquelet-induced membrane technique involves placing a cement spacer in the defect to create a biologically active membrane. In the second stage, the gold standard for filling the defect is an autologous cancellous bone graft of 1–2 mm in size. This study aims to examine the effects of using a non-vascularized fibula as a support combined with a cancellous graft in the Masquelet technique for treating compound fractures of the distal femur. MethodsThe study was conducted between December 2017 and December 2020 and included 11 patients who underwent the Masquelet technique. The procedure involved a lateral locked plate and an antibiotic-impregnated bone cement spacer, followed by a 20–30 mm longer ipsilateral fibula used as a strut graft. The remaining area was filled with cancellous bone from the iliac crest. The size of the defect, Time to the bony union, the average range of motion of the knee, and any complications are analysed. The final evaluation was done at 18 months using the Lower Extremity functional scale to assess functional outcomes. ResultsThe study included 11 patients (8 male and 3 female) with a mean age of 45.8 years. The average time to bony union was 6.6 months, and the average range of motion of the knee was 2.2° to 93.3 ° (0–110 °). No complications such as infection, non-union, or implant failure were observed. ConclusionThe Masquelet Technique combined with a fibular strut graft is a feasible solution for complex distal femur fractures with bone loss. The non-vascularized fibula graft provides both structural support and reduces the amount of cancellous bone graft needed, which results in earlier weight bearing and improved functional outcomes.

Comparison of the Therapeutic Efficacy of Antibiotic-Loaded Polymeric Tissue Scaffold and Bone Cement in the Regeneration of Infected Bone Tissue.

Background Local antibiotic applications have been used in chronic osteomyelitis and have been defined as an adjunctive treatment method. Biodegradable materials are also used for the same purpose by adding antibiotics. The fact that it does not require additional surgery to be removed is an important advantage. In this study, we intended to develop a new biodegradable drug-loaded polymeric scaffold with good antibiotic release and compare the microbiological results with antibiotic-impregnated bone cement. Methodology A tissue scaffold containing poly(2-hydroxyethyl methacrylate) (PHEMA) was prepared in our laboratory and loaded with ertapenem and daptomycin antibiotics. The surface morphology and pore geometries of drug-loaded and unloaded scaffolds were analyzed by a scanning electron microscope under vacuum. The dose-dependent antiproliferative effects of PHEMA scaffold, drug-loaded scaffold, cement, and drug-loaded cement on osteoblast cells were investigated. To evaluate drug release kinetics, the absorbance values of the scaffold loaded with ertapenem and daptomycin were measured with the spectrometer. For microbiological tests, ertapenem and daptomycin-impregnated cement and scaffold, as well as the control scaffold and cement samples, were investigated for their antibacterial activities on Staphylococcus aureus and Klebsiella pneumoniae strains using the disc diffusion method. These microorganisms are one of the most common microorganisms in osteomyelitis. Results The efficacy of antibiotic-impregnated scaffold and cement on both gram-negative and gram-positive microorganisms was investigated. The daptomycin zone diameter in S. aureus ATCC 29233 strain was 17 mm, whereas it was 24 mm for scaffold and 22 mm for cement. Scaffold was found to be more effective than cement against S. aureus strain. The K. pneumoniae ATCC BAA-2814 strain was found to be resistant to ertapenem, but the zone diameter was 21 mm for scaffold and 20 mm for cement. Ertapenem-loaded scaffold was found to be more effective than cement. It was found that the antimicrobial activity of the scaffold was higher than cement. When we evaluated the release profiles,for the daptomycin-loaded cement group, 98% of daptomycin was cumulatively released within 30 minutes, and for the daptomycin-loaded scaffold group, 100% of daptomycin was cumulatively released in six days. To compare ertapenem-loaded cement and scaffold, 98% of ertapenem was cumulatively released within 10 minutes in the cement group. For the scaffold group, 100% of ertapenem was cumulatively released in 17 days. We found that the scaffold released the antibiotic more slowly and for a longer duration. Therefore, it was thought that the scaffold would be more effective on biofilm and the treatment of osteomyelitis would be more successful. Conclusions The produced scaffold was compared with cement, and it was concluded that the scaffold had better release and antimicrobial efficacy. Scaffold is more advantageous than cement because it is bioeliminable. Thus, there is no need for a second surgical intervention with the likely prevention of mortality and morbidity. Becauseof all these features, the scaffold seems promising in the local treatment of osteomyelitis.

Two-stage reconstruction using a vancomycin-impregnated cement spacer for finger osteomyelitis with bone and joint destruction

ObjectivesSeptic arthritis and osteomyelitis are serious infections. Several treatment methods for the small joints and bones of the hands have been reported. We hypothesized that antibiotic-impregnated cement spacers could be useful for purulent finger osteomyelitis with bone and joint destruction. Patients and methodsSeven patients with finger osteomyelitis with bone and joint destruction were treated using vancomycin (VCM)-impregnated cement spacers. During the first surgery, a cement spacer was placed in the space created after debridement, maintaining finger length. Intraoperative specimens were tested for bacterial growth. Systemic antibiotic treatment was administered. A second surgery was performed 6–8 weeks after the first. After spacer removal, reconstruction surgeries were performed: arthrodesis using the Masquelet technique (n = 5), vascularized bone grafting (n = 1), and silicone implant arthroplasty (n = 1). We assessed the pathogenic bacteria, duration of antibiotic treatment, infection control, time to bone union, pain on visual analogue scale (VAS) (0 − 100), total active motion (TAM) of the affected fingers, and grip strength. ResultsThe pathogenic bacteria were methicillin-sensitive Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and unknown in 3, 3, and 1 patients, respectively. Mean duration of antibiotic treatment was 6.4 weeks. In all patients, infection resolved without recurrence. One patient underwent joint arthroplasty; otherwise, bone union was achieved in 6 patients. Mean VAS score for pain was 0.9. Mean TAM was 147° for the index and middle fingers and 50° for the thumb. Mean grip strength was 86.4% of that of the unaffected side. ConclusionVCM-impregnated cement spacers could be useful for finger osteomyelitis, facilitating effective infection control and the maintenance of finger length, even in severe conditions.

High Incidence of Acute Kidney Injury Following Antibiotic-Loaded Spacer Insertion for Periprosthetic Joint Infection: An Updated Review of the Literature

BackgroundThe use of antibiotic-impregnated cement during 2-stage revision arthroplasty for periprosthetic joint infection poses a risk of renal complications following spacer insertion. This systematic review aimed to investigate the rate of acute kidney injury (AKI) following antibiotic-loaded spacer insertion and to identify risk factors associated with this complication. MethodsA systematic review was performed using PubMed, Cochrane Central, and Scopus databases. All clinical studies that documented renal complications following antibiotic-loaded spacer insertion for periprosthetic knee (total knee arthroplasty [TKA]) or hip (total hip arthroplasty [THA]) infection were included. Articles that combined THA and TKA outcomes were also included and labeled “THA + TKA.” Descriptive statistics were analyzed when data were available. ResultsThere were 24 studies (9 THA, 7 TKA, 8 THA + TKA) included. The mean incidences of spacer-related AKI across THA, TKA, and THA + TKA cohorts were 4.2 (range, 0 to 10%), 14 (range, 0 to 19%), and 27% (range, 0 to 35%), respectively. The most common patient-related risk factors for AKI were underlying chronic kidney disease or high baseline creatinine, low preoperative hemoglobin, and blood transfusion requirement. Spacer-related risk factors included high antibiotic dosage (>3.6 g/cement batch) and antibiotic type. While most recovered without complication, select patients required hemodialysis for acute management (2 THA, 18 THA + TKA) and/or developed chronic kidney disease (8 TKA, 8 THA). ConclusionThe rate of AKI following spacer insertion was high and likely under-reported in the literature. Surgeons should be cognizant of this devastating complication and should closely monitor at-risk patients for AKI following antibiotic-loaded spacer insertion.

Limb Salvage in Diabetic Patients With Combination of Radical Excision, Antibiotic Impregnated Bone Cement, and External Fixator Application

In patients with diabetes, foot ulceration is a major cause of morbidity and hospitalization. The combination of deep ulcers and underlying osteomyelitis in patients with diabetes frequently leads to chronic nonhealing foot ulcers. These patients have often ended up with amputation. From 2003 to 2017, 17 of 175 diabetic patients (11 males and 6 females, 37 to 82 y old) were treated for diabetic foot and presented with complaints of ulceration, osteomyelitis, and foot gangrene. Magnetic resonance imaging–guided necrotic tissue debridement was performed, after the placement of antibiotic-impregnated bone cement, and soft tissue defect reduction was performed with an external fixator. Approximately 4 weeks later, polymethylmethacrylate was removed, and then the external fixator was removed after the soft tissue defect was closed. No patients had recurrent ulceration or osteomyelitis seen on radiographs up to their latest follow-up. There was pin tract infection in 2 patients who were treated with oral antibiotics and wound dressings. All patients have a fibrous union in the metatarsophalangeal joint. Compared with other radical techniques such as amputation, amputation, and long-term wound dressings, salvage of limbs with an external fixation can be used in selected patients who have osteomyelitis and soft tissue defects after debridement. Level of Evidence: Diagnostic level III—nonrandomized controlled cohort study.

Comparison of antibiotic-impregnated bone cement coverage versus vacuum sealing drainage in semi-open bone grafting using for tibial fracture with infected bone and soft tissue defect: a retrospective analysis

ObjectiveTo compare antibiotic-impregnated bone cement coverage (bone cement surface technique; BCS-T) versus vacuum sealing drainage (VSD) for tibial fracture with infected bone and soft tissue defect.MethodThis retrospective analysis compared the clinical outcomes in patients undergoing BCS-T (n = 16) versus VSD (n = 15) for tibial fracture with infected bone and soft tissue defect at the Third Hospital of Hebei Medical University from March 2014 to August 2019. For BCS-T group, osseous cavity was filled with autograft bone graft after debridement, and then the wound was covered with a 3-mm layer of bone cement impregnated with vancomycin and gentamycin. The dressing was changed every day in the first week, and every 2 ~ 3 days in the second week. For VSD group, a negative pressure of -150 ~ -350 mmHg was maintained, and the dressing was changed every 5–7 days. All patients received antibiotics treatment based on bacterial culture results for 2 weeks.ResultsThe 2 groups did not differ in age, sex and key baseline characteristics, including type of Gustilo-Anderson classification, size of the bone and soft tissue defect, the percentage of primary debridement, bone transport, and the time from injury to bone grafting. The median follow-up was 18.9 months (range:12–40). The time to complete coverage of bone graft by granulation tissue was 21.2 (15.0–44.0) and 20.3 (15.0–24.0) days in the BCS-T and VSD groups, respectively (p = 0.412). The 2 groups also did not differ in wound healing time (3.3 (1.5–5.5) versus 3.2(1.5–6.5) months; p = 0.229) and bone defect healing time (5.4(3.0-9.6) versus 5.9(3.2–11.5) months; p = 0.402). However, the cost of covering material was significantly reduced in the BCS-T group (2071 ± 134 versus 5542 ± 905 yuan; p = 0.026). Paley functional classification at 12 months did not differ between the 2 groups (excellent in 87.5% versus 93.3% in the 2 groups; p = 0.306).ConclusionBCS-T could achieve clinical outcomes similar to VSD in patients receiving bone graft for tibial fracture with infected bone and soft tissue defect, but material cost was significantly reduced. Randomized controlled trials are needed to verify our finding.

Clinical outcomes following treatment of deep surgical site infection after fixation of calcaneal fractures: A retrospective case-control study

IntroductionDeep surgical site infection (SSI) may be a complication of open reduction and internal fixation (ORIF) of calcaneal fractures. This study aimed to describe the characteristics of patients with deep SSI following ORIF of calcaneal fractures via extensile lateral approach (ELA). We compared clinical outcomes of these patients, with a minimum follow-up of one year after successful treatment of deep SSI with a matched control group. MethodsIn this retrospective case-control study, demographic data, fracture characteristics, bacterial pathogens, medical treatments and surgical approaches were collected, also the outcome was evaluated by the visual analog scale (VAS) for pain, foot function index (FFI) and AOFAS ankle-hindfoot score. The differences in Böhler and Gissane's angles between infected and contralateral feet were measured. By matching a control group of uninfected cases, clinical outcomes were compared between 2 groups using the Mann–Whitney U test. ResultsAmong 331 calcaneus fractures in 308 patients (mean age, 38.0 ± 13.1; male/female ratio, 5.5), 21 had deep SSI (6.3 %). There were 16 (76.2 %) males and 5 (23.8 %) females with a mean age of 35.1 ± 11.7 years. Thirteen (61.9 %) patients had unilateral fractures. The most common Sanders Type was found to be type II. The most frequent type of detected microorganisms was Staphylococcus species. Intravenous antibiotic therapy, mostly clindamycin, imipenem and vancomycin, based on the microbiological results, was prescribed with a mean±SD duration of 28.1 ± 16.5 days. The mean number of surgical debridements was 1.8 ± 1.3. Implants needed to be removed in 16 (76.2 %) cases. Antibiotic-impregnated bone cement was applied in three (14.3 %) cases. The clinical outcomes of 15 cases (follow up, 35.5 ± 13.8; range, 12.6–64.5 months) were 4.1 ± 2.0, 16.7 ± 12.3 and 77.5 ± 20.8 for VAS for pain, FFI % and AOFAS ankle-hindfoot score, respectively. Comparing with the control group (VAS for pain, 2.3 ± 2.7; FFI %, 12.2 ± 16.6, and AOFAS, 84.6 ± 18.0), only VAS pain was statistically lower in this group (p-value: 0.012). The differences in Böhler and Gissane's angles between both feet of infected cases were − 14.3 ± 17.9 and − 7.7 ± 22.5 (worse in the infected side), respectively. ConclusionProper on-time approaches to deep infection following ORIF of calcaneal fractures may lead to acceptable clinical and functional outcomes. Sometimes aggressive approaches with intravenous antibiotic therapy, multiple sessions of surgical debridement, removal of implants and antibiotic impregnated cement are necessary to eradicate deep infection. Level of evidenceLevel III.

Retrograde Intramedullary Antibiotic Impregnated Cement Nailing for Treatment of Infected Primary Tibiotalocalcaneal Arthrodesis

The management of infected primary tibiotalocalcaneal arthrodesis (TTCA) is a daunting task for foot and ankle surgeons. For the last 2 decades, antibiotic bone cement nails have become a method to treat intramedullary infections, such as those seen in infected TTCA, as they provide the dual benefits of eluting high amounts of antibiotics into medullary canal while providing some stability to the bone. Studies have demonstrated the effectiveness of this salvage technique in treating infected primary TTCA. Because of the lack of commercially available antibiotic impregnated nails for this procedure, there is significant variation in techniques utilized. In addition, the rarity of these cases can make execution of this technique difficult and time consuming. To date there is no comprehensive technique guide for this procedure. We present a detailed photographic record and technical details of a modified technique for employing an antibiotic spacer nail for a 64-year-old female patient undergoing revision TTCA. The patient had an uncomplicated postoperative clinical course with no evidence of wound infection. Her osteomyelitis subsequently resolved, and she was able to ambulate with minimal pain with a Charcot Restraint Orthotic Walker. Surgeons can utilize the technical pearls presented herein to help reduce the amount of time spent in the operating room performing these clinically challenging revisions. Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.

Effectiveness of two-stage revision with commercial polymethylmethacrylate articulated hip spacer: similar outcomes against monomicrobial and polymicrobial hip periprosthetic joint infections.

Background: orthopaedic surgeons still struggle against a devastating complication - periprosthetic joint infection (PJI). A two-stage revision is considered the gold standard for chronic PJI for several authors, with success rates over 90 %. This strategy implies the remotion of the prosthesis and the implantation of an antibiotic-impregnated cement spacer in the joint. The primary objective of this study was to assess the effectiveness of a two-stage revision approach using a commercial prefabricated antibiotic-impregnated cement hip spacer for the treatment of hip PJI regarding monomicrobial and polymicrobial infections. Secondly, to assess risk factors for failure of two-stage revision. Material and methods: we conducted a retrospective study on patients that underwent revision of total hip arthroplasty (THA) between January2002 and January20218. We included adult patients with a diagnosis of chronic hip PJI that underwent two-stage revision using a prefabricated gentamicin-impregnated cement of polymethylmethacrylate (PMMA) hip spacer. We assessed whether it was monomicrobial or polymicrobial infections and comorbidities. Treatment success was defined when eradication of the infection was observed and no further procedures or mortality were registered after the second stage. Persistence or recurrence of infection was considered a failure of treatment. Results: the final series consisted of 84patients treated with the same hip spacer: 60 (71.4 %) monomicrobial and 24 (28.6 %) polymicrobial joint infections with an overall follow-up of 59.0 (36.0-84.0) months. The overall success rate was 90.5 %. Eight (9.5 %) patients failed. Smoking and BMI greater than 30 m kg were identified independent risk factors for failure in multivariate analysis. Conclusion: our study suggests that prefabricated gentamicin-impregnated PMMA spacer is an effective tool for the treatment of PJI, achieving similar outcomes whether it is monomicrobial or polymicrobial infections. Randomized prospective studies are needed to obtain more reliable conclusions.

Outcome of intramedullary nail coated with antibiotic-impregnated cement in chronic osteomyelitis.

Chronic osteomyelitis (Chr OM) may result as a sequel of acute hematogenous infection or following open fractures or orthopedic surgeries. Among various osteoarticular infections, Chr OM is one of the most challenging in terms of treatment. In the present study, we evaluate the outcome of antibiotic cement-coated nails in the treatment of chronic pyogenic osteomyelitis and also discuss the future innovations in field of antibiotic-compatible biomaterials for coating the implants. Twelve cases of Chr OM (5 hematogenous and 7 exogenous following trauma or surgery) were operated by intramedullary nail coated with antibiotic-impregnated bone cement from September 2018 to January 2021. All the cases had bacteriological confirmation of infection by deep curettage and its subsequent culture sensitivity. K nail was used in 10 cases and elastic stable intramedullary nails were used in 2 cases. Out of 12 cases, 8 were male and 4 were female. The average duration of follow-up was 13 months. Infection was controlled in all the cases (two cases required repeat antibiotic-coated nailing), and there was no incidence of relapse in any case. The control of infection was assessed by clinical assessment and laboratory parameters. Antibiotic cement-coated nails are an effective method in local control of infection in Chr OM without any systemic side effect.

Simple and cost-effective way to make mobile antibiotic cement spacer: hand-made silicone mold

Background: Two-stage exchange arthroplasty is considered the most common approach for the management of prosthetic joint infections. There has been plentiful evidence to support the superiority of the mobile spacers over the static ones. Unfortunately, articulating options are not available in our low-resource environment, which motivated us to come up with an affordable way to create a mobile cement spacer. After experimenting with a variety of materials and producing methods, we realized that silicone is a favorable material for mold building and established a simple process of making a handmade silicone mold. We demonstrate the clinical outcomes of three prosthetic joint infections by using these spacers in the hope of spreading the idea to our colleagues who work in the circumstances of a developing country. Construction of the spacer molds: The molds, consisting of two parts, were shaped by using high viscosity addition silicone (elite HD+ putty soft, Zhermack SpA, Italy) as material, and previously removed implants as template. They were sterilized using ethylene oxide treatment before being ready for casting antibiotic-loaded bone cement spacer. Case report: Three cases of prosthetic infection were treated with two-stage revision, using antibiotic-impregnated cement spacer cast in hand-made silicone molds. We sought to determine intraoperative complications, postoperative range of motion, and functional scores. All the patients were regularly followed up to identify fractures or dislocation of the spacer, and reinfection. Results: At the end of the follow-up, all three patients had the infection eradicated. The three patients could sit comfortably with bent knees, walk with partial weight-bearing, and achieve 75–80 degrees of knee flexion in the first week after surgery. Follow-up X-rays revealed no fractures or dislocation in any of the spacers. Conclusion: Silicone molds offer a simple and cost-effective alternative to costly commercial products in producing articulating spacers. Treating infected joints arthroplasty with these spacers allows for early motion and partial weight bearing and improves patient satisfaction and life quality before reimplantation without significant complications.

Impact of Antibiotic-Impregnated Spacer Design in the Treatment of Periprosthetic Hip Infection.

Although 2-stage exchange arthroplasty, consisting of temporary insertion of an antibiotic-impregnated cement spacer (AICS), is considered the standard of care for chronic periprosthetic joint infection (PJI) in total hip arthroplasty (THA), a consensus on the AICS design has not yet been established. Ceramic-on-polyethylene AICSs (Poly-AICS) are theorized to cause less pain and better function than cement-on-bone AICS (CemB-AICS) but use non-antibiotic-impregnated components that may harbor bacteria. This study evaluates the impact of spacer design on infection-free survivorship following THA reimplantation as well as pain and function during the interim AICS stage. A retrospective review was performed of all cases of THA PJI treated with either Poly-AICS or CemB-AICS at a single high-volume academic center. Data were collected until the final follow-up after THA reimplantation with an average follow-up duration of 2.6 years. The primary outcome was infection-free survivorship after the final reimplantation. Secondary outcomes included postoperative pain scores, opioid use, time to ambulation, length of stay, complications, and discharge disposition. A total of 99 cases (67 CemB-AICS; 32 Poly-AICS) were included. There were no baseline differences between the 2 groups. There were no differences in infection-free survivorship after reimplantation in survivorship curve comparisons (P= .122) and no differences in postoperative inpatient pain scores, opioid use, length of stay, time to ambulation, complications, or discharge disposition during the AICS stage. Patients with THA PJI treated with Poly-AICS did not have worse infection-related outcomes despite the use of non-antibiotic-impregnated components but also did not appear to have less pain or improved function during the early AICS stage.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

A Novel Technique for Creating a 3D-Printed Total Talus Antibiotic-Impregnated Cement Spacer for a Rare Case of Osteomyelitis of the Talus

A Novel Technique for Creating a 3D-Printed Total Talus Antibiotic-Impregnated Cement Spacer for a Rare Case of Osteomyelitis of the Talus