Antibiotic-impregnated PMMA hip spacers: Current status

The infection rate after primary hip arthroplasty lies at 1–2%. In the past few years, a two-stage protocol with the implantation of an antibiotic-loaded spacer has become a popular procedure in the treatment of infected hip joint arthroplasties. In this review, we pay special attention to the elution characteristics of the spacers, their mechanical stability and the clinical response. We conclude that hip spacers are an effective method in the treatment of hip joint infections, with success rates of over 90%.

[1]  J. Ohnsorge,et al.  Treatment of an old infection in a total hip replacement with an interim spacer prosthesis , 2004, Archives of Orthopaedic and Trauma Surgery.

[2]  D. Dall,et al.  Bone cement and antibiotics. , 1977, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[3]  Mel S. Lee,et al.  Treatment of deep infection of the hip associated with massive bone loss: two-stage revision with an antibiotic-loaded interim cement prosthesis followed by reconstruction with allograft. , 2005, The Journal of bone and joint surgery. British volume.

[4]  Gladius Lewis,et al.  Fatigue testing and performance of acrylic bone-cement materials: state-of-the-art review. , 2003, Journal of biomedical materials research. Part B, Applied biomaterials.

[5]  A. Benini,et al.  Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. , 2004, The Journal of antimicrobial chemotherapy.

[6]  S. Affatato,et al.  Investigations on the wear behaviour of the temporary PMMA-based hip Spacer-G® , 2003, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[7]  R. Deshmukh,et al.  An intramedullary cement spacer in total hip arthroplasty . , 1998, The Journal of arthroplasty.

[8]  H. Buchholz,et al.  [Depot effects of various antibiotics mixed with Palacos resins]. , 1970, Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen.

[9]  Kengo Yamamoto,et al.  Clinical effectiveness of antibiotic-impregnated cement spacers for the treatment of infected implants of the hip joint , 2003, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[10]  G. Marshall,et al.  Mechanical properties of bone cements containing large doses of antibiotic powders. , 1976, Journal of biomedical materials research.

[11]  R. Uhl,et al.  Spacer endoprosthesis for the treatment of infected total hip arthroplasty. , 2004, The Journal of arthroplasty.

[12]  M. Ries,et al.  An inexpensive molding method for antibiotic-impregnated cement spacers in infected total hip arthroplasty. , 1999, The Journal of arthroplasty.

[13]  B. Masri,et al.  Treatment of Infection Associated with Segmental Bone Loss in the Proximal Part of the Femur in Two Stages with Use of an Antibiotic-Loaded Interval Prosthesis* , 1998, The Journal of bone and joint surgery. American volume.

[14]  L. Lidgren,et al.  Bone cement improved by vacuum mixing and chilling. , 1987, Acta orthopaedica Scandinavica.

[15]  J. Krämer,et al.  Osteomyelitis nach Endoprothesen , 2004, Der Orthopäde.

[16]  H. Amstutz,et al.  Direct-Exchange Arthroplasty for the Treatment of Infection after Total Hip Replacement. An Average Ten-Year Follow-up* , 1998, The Journal of bone and joint surgery. American volume.

[17]  R. Haaker,et al.  [Osteomyelitis after endoprostheses]. , 2004, Der Orthopade.

[18]  David Jahoda,et al.  Zweizeitige Operation zur Behandlung tiefer Infektionen bei Hüftendoprothesen unter Verwendung eines kanülierten Platzhalters , 2003, Operative Orthopädie und Traumatologie.

[19]  T. Sculco,et al.  Technique for fabrication of an antibiotic-loaded cement hemiarthroplasty (ANTILOCH) prosthesis for infected total hip arthroplasty. , 2002, American journal of orthopedics.

[20]  A. Eckardt,et al.  Individual bone cement spacers (IBCS) for septic hip revision—preliminary report , 2003, Archives of Orthopaedic and Trauma Surgery.

[21]  W. Abendschein.  Salvage of infected total hip replacement: use of antibiotic/PMMA spacer. , 1992, Orthopedics.

[22]  F. Haddad,et al.  The treatment of the infected hip replacement. The complex case. , 1999, Clinical orthopaedics and related research.

[23]  P. D. Levin.  The effectiveness of various antibiotics in methyl methacrylate. , 1975, The Journal of bone and joint surgery. British volume.

[24]  M. Itoman,et al.  Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer , 2003, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[25]  J. Kelm,et al.  In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers. , 2005, Journal of biomedical materials research. Part B, Applied biomaterials.

[26]  B. Masri,et al.  Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. , 1998, The Journal of arthroplasty.

[27]  D. Regis,et al.  Preformed acrylic bone cement spacer loaded with antibiotics: Use of two-stage procedure in 10 patients because of infected hips after total replacement , 2001, Acta orthopaedica Scandinavica.

[28]  C. A. Warren,et al.  Relation of surface area to in vitro elution characteristics of vancomycin-impregnated polymethylmethacrylate spacers. , 1998, American journal of orthopedics.

[29]  W. Murray.  Use of antibiotic-containing bone cement. , 1984, Clinical orthopaedics and related research.

[30]  P. Meere,et al.  A simple method for construction of an articulating antibiotic-loaded cement spacer. , 2002, The Journal of arthroplasty.

[31]  M. Askew,et al.  Effect of vacuum mixing on the mechanical properties of antibiotic-impregnated polymethylmethacrylate bone cement. , 1990, Journal of biomedical materials research.

[32]  Mel S. Lee,et al.  Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. , 2004, The Journal of bone and joint surgery. American volume.

[33]  P. D. Di Cesare,et al.  Use of Antibiotic‐Impregnated Cement in Total Joint Arthroplasty , 2003, The Journal of the American Academy of Orthopaedic Surgeons.

[34]  C. Duncan,et al.  A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. , 1993, The Orthopedic clinics of North America.

[35]  R. Barrack.  Rush pin technique for temporary antibiotic-impregnated cement prosthesis for infected total hip arthroplasty. , 2002, The Journal of arthroplasty.

[36]  R. Tandoğan,et al.  Two-stage treatment of chronic staphylococcal orthopaedic implant-related infections using vancomycin impregnated PMMA spacer and rifampin containing antibiotic protocol. , 1999, Bulletin (Hospital for Joint Diseases (New York, N.Y.)).

[37]  B. McGrory,et al.  A simple method of intra-articular antibiotic delivery in infected hip arthroplasty. , 2002, American journal of orthopedics.

[38]  Hae-Ryong Song,et al.  Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. , 2001, The Journal of arthroplasty.

[39]  R. McGraw,et al.  The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. , 1997, The Journal of arthroplasty.

[40]  R. Ganz,et al.  A cement spacer for two-stage revision of infected implants of the hip joint , 1998, International Orthopaedics.

[41]  V. Goldberg,et al.  Use of an antibiotic impregnated polymethyl methacrylate intramedullary spacer for complicated revision total hip arthroplasty. , 1992, The Journal of arthroplasty.

[42]  I. Learmonth,et al.  Mechanical characteristics of antibiotic-laden bone cement , 2002, Acta orthopaedica Scandinavica.

[43]  Ľ. Drgoňa,et al.  Nosocomial bacteremia due to vancomycin-resistantStaphylococcus epidermidis in four patients with cancer, neutropenia, and previous treatment with vancomycin , 1996, European Journal of Clinical Microbiology and Infectious Diseases.

[44]  D. Bouchier‐Hayes,et al.  Development of resistant strains of Staphylococcus epidermidis on gentamicin-loaded bone cement in vivo. , 2002, The Journal of bone and joint surgery. British volume.

[45]  G. Waertel.  The role of antibiotic-loaded cement in the treatment of an infection after a hip replacement. , 1996, The Journal of bone and joint surgery. American volume.

[46]  M. Wagner,et al.  [Infected hip joint prosthesis. Viewpoints for 1-stage and 2-stage prosthesis exchange]. , 1995, Der Orthopade.

[47]  S. Maruo,et al.  Successful reimplantation of total femoral prosthesis after deep infection. , 2003, The Journal of arthroplasty.

[48]  H. Neu,et al.  The Crisis in Antibiotic Resistance , 1992, Science.

[49]  E. Bouza,et al.  Emergence of teicoplanin-resistant coagulase-negative staphylococci , 1996, Journal of clinical microbiology.

[50]  O. Wahlström,et al.  Revision of infected hip replacement. Two-stage procedure with a temporary gentamicin spacer. , 1994, Acta orthopaedica Scandinavica.