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Procedure for single-stage implant retention for chronic periprosthetic infection using topical degradable calcium-based antibiotics

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Abstract

Introduction

Surgical treatment using DAIR (debridement, systemic antibiotics, and implant retention) can lead to high rates of treatment success in cases of early periprosthetic joint infection (PJI) but can fail in late-onset cases. Supplementary local antibiotic therapy is not yet generally established and lacks evidence-based proof of efficacy. The aim of this study was to analyze DAIR outcomes in recurrent PJI cases and patients who are not suitable for a two-stage exchange, using additional degradable calcium-based antibiotics.

Methods

All patients fulfilled the Infectious Diseases Society of America (IDSA) guidelines for chronic late-onset PJI but were not suitable for a multistage procedure because of their individual operation risk. A total of 42 patients (mean age, 73 years) were treated using a single-stage algorithm consisting of DAIR, followed by implantation of degradable antibiotics chosen in accordance with an antibiogram. OSTEOSET® (admixed ceftriaxone/vancomycin/tobramycin) and Herafill-Gentamycin® were used as carrier systems. The follow-up period was 23 months (± SD, 10.3). The study is based on institutional review board (IRB) approval.

Results

The clinical entities were chronic PJI of the hip (45.2%), knee (28.6%), and knee arthrodesis (26.2%). The bacterial spectrum was composed of Staphylococcus epidermidis (29%), Staphylococcus aureus (21%), and Enterococcus faecalis (21%). 21.4% showed a combination of two or more bacteria. In 73.8%, permanent remission was achieved, while 11.9% showed chronic PJI under implant retention. Implant retention could be achieved in 85.7%.

Conclusion

DAIR usually shows low levels of success in difficult-to-treat cases. However, we could demonstrate the successful treatment of patients with recurrent PJI (typically considered DAIR-inappropriate) using degradable antibiogram-based topical calcium-based antibiotics. Over 70% of the cases went to remission and over 85% of the implants could be retained.

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Authors and Affiliations

  1. Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstr. 430, 60389, Frankfurt am Main, Germany

    Yves Gramlich, Gerhard Walter, Alexander Klug, Johannes Harbering, Matthias Kemmerer & Reinhard Hoffmann

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  1. Yves Gramlich
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  2. Gerhard Walter
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  3. Alexander Klug
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  6. Reinhard Hoffmann
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Correspondence to Yves Gramlich.

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The study is based on institutional review board (IRB) approval.

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Gramlich, Y., Walter, G., Klug, A. et al. Procedure for single-stage implant retention for chronic periprosthetic infection using topical degradable calcium-based antibiotics. International Orthopaedics (SICOT) 43, 1559–1566 (2019). https://doi.org/10.1007/s00264-018-4066-9

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