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Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

Infection of a hip prosthesis is one of the most severe complications encountered in orthopedic practice. Two-stage reconstruction using an antibiotic-impregnated cement spacer has become a popular procedure for the treatment of this condition. However, there are some disadvantages with the use of antibiotic-loaded cement, including low biocompatibility, a very low release ratio, and the possibility of thermal damage to the antibiotic. We have developed an effective drug delivery system for osteomyelitis in which porous hydroxyapatite (HA) blocks are loaded with an antibiotic by the vacuum method. We report here a modification of this delivery system applied for the first stage of two-stage reconstruction surgery against infected hip prosthesis.

Patients and methods

Eight consecutive patients who developed hip prosthesis infection underwent two-stage revision total hip arthroplasty (THA) using antibiotic-loaded porous HA blocks prepared by the vacuum method. Thorough debridement and insertion of antibiotic-loaded HA blocks was performed in the first stage, followed by conversion to THA after eradication of infection in the second stage.

Results

The mean interval between the stages was 16.8 weeks. There were no complications related to the use of the antibiotic-loaded HA blocks. The patients were followed up for an average of 49 months with no evidence of recurrent infection. The mean Japanese Orthopedic Association hip score improved from 45.1 before surgery to 79.6 at the latest follow-up.

Interpretation

This simple approach utilizing antibiotic-impregnated HA blocks prepared by the vacuum method is considered to be effective for treatment of hip prosthesis infection.

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References

  1. Salvati EA, Gonzalez Della Valle A, Masri BA, Duncan CP (2003) The infected total hip arthroplasty. Instr Course Lect 52:223–245

    PubMed  Google Scholar 

  2. Hanssen AD, Rand JA (1999) Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. Instr Course Lect 48:111–122

    CAS  PubMed  Google Scholar 

  3. Crockarell JR, Hanssen AD, Osmon DR, Morrey BF (1998) Treatment of infection with debridement and retention of the components following hip arthroplasty. J Bone Joint Surg Am 80:1306–1313

    CAS  PubMed  Google Scholar 

  4. Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am 78:512–523

    CAS  PubMed  Google Scholar 

  5. Moyad TF, Thornhill T, Estok D (2008) Evaluation and management of the infected total hip and knee. Orthopedics 31:581–588 (quiz 589–590)

    Article  PubMed  Google Scholar 

  6. Hsieh PH, Chen LH, Chen CH, Lee MS, Yang WE, Shih CH (2004) Two-stage revision hip arthroplasty for infection with a custom-made, antibiotic-loaded, cement prosthesis as an interim spacer. J Trauma 56:1247–1252

    Article  PubMed  Google Scholar 

  7. Diwanji SR, Kong IK, Park YH, Cho SG, Song EK, Yoon TR (2008) Two-stage reconstruction of infected hip joints. J Arthroplasty 23:656–661

    Article  PubMed  Google Scholar 

  8. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89:871–882

    Article  PubMed  Google Scholar 

  9. Anagnostakos K, Furst O, Kelm J (2006) Antibiotic-impregnated PMMA hip spacers: current status. Acta Orthop 77:628–637

    Article  PubMed  Google Scholar 

  10. Takahira N, Itoman M, Higashi K, Uchiyama K, Miyabe M, Naruse K (2003) Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer. J Orthop Sci 8:26–31

    Article  PubMed  Google Scholar 

  11. Leunig M, Chosa E, Speck M, Ganz R (1998) A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop 22:209–214

    Article  CAS  PubMed  Google Scholar 

  12. Younger AS, Duncan CP, Masri BA, McGraw RW (1997) The outcome of two-stage arthroplasty using a custom-made interval spacer to treat the infected hip. J Arthroplasty 12:615–623

    Article  CAS  PubMed  Google Scholar 

  13. Magnan B, Regis D, Biscaglia R, Bartolozzi P (2001) Preformed acrylic bone cement spacer loaded with antibiotics: use of two-stage procedure in 10 patients because of infected hips after total replacement. Acta Orthop Scand 72:591–594

    Article  CAS  PubMed  Google Scholar 

  14. Yamamoto K, Miyagawa N, Masaoka T, Katori Y, Shishido T, Imakiire A (2003) Clinical effectiveness of antibiotic-impregnated cement spacers for the treatment of infected implants of the hip joint. J Orthop Sci 8:823–828

    Article  PubMed  Google Scholar 

  15. Duncan CP, Beauchamp C (1993) A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 24:751–759

    CAS  PubMed  Google Scholar 

  16. Hoff SF, Fitzgerald RH Jr, Kelly PJ (1981) The depot administration of penicillin G and gentamicin in acrylic bone cement. J Bone Joint Surg Am 63:798–804

    CAS  PubMed  Google Scholar 

  17. Cerretani D, Giorgi G, Fornara P, Bocchi L, Neri L, Ceffa R, Ghisellini F, Ritter MA (2002) The in vitro elution characteristics of vancomycin combined with imipenem-cilastatin in acrylic bone-cements: a pharmacokinetic study. J Arthroplasty 17:619–626

    Article  PubMed  Google Scholar 

  18. Itokazu M, Aoki T, Nonomura H, Nishimoto Y, Itoh Y (1998) Antibiotic-loaded porous hydroxyapatite blocks for the treatment of osteomyelitis and postoperative infection. A preliminary report. Bull Hosp Jt Dis 57:125–129

    CAS  PubMed  Google Scholar 

  19. Itokazu M, Esaki M, Yamamoto K, Tanemori T, Kasai T (1999) Local drug delivery system using ceramics: vacuum method for impregnating a chemotherapeutic agent into a porous hydroxyapatite block. J Mater Sci Mater Med 10:249–252

    Article  CAS  PubMed  Google Scholar 

  20. Itokazu M, Matsunaga T, Kumazawa S, Yang W (1995) A novel drug delivery system for osteomyelitis using porous hydroxyapatite blocks loaded by centrifugation. J Appl Biomater 6:167–169

    Article  CAS  PubMed  Google Scholar 

  21. Itokazu M, Yang W, Aoki T, Ohara A, Kato N (1998) Synthesis of antibiotic-loaded interporous hydroxyapatite blocks by vacuum method and in vitro drug release testing. Biomaterials 19:817–819

    Article  CAS  PubMed  Google Scholar 

  22. Itokazu M, Itoh Y, Fukuta M, Miyamoto K, Ohara A, Oshima K, Nishimoto Y, Ohno T, Kasai T, Shimizu K (1999) Treatment of osteomyelitis by using antibiotic-loaded porous ceramics. Bioceramics 12:3–6

    CAS  Google Scholar 

  23. Matsumoto K, Itokazu M, Uemura S, Takigami I, Naganawa T, Shimizu K (2007) Successful joint arthroplasty after treatment of destructive MRSA arthritis of the knee using antibiotic-loaded hydroxyapatite blocks: a case report. Arch Orthop Trauma Surg 127:47–50

    Article  PubMed  Google Scholar 

  24. Tanaka S (1978) Surface replacement of the hip joint. Clin Orthop Relat Res 134:75–79

    Google Scholar 

  25. Athanasou NA, Pandey R, de Steiger R, Crook D, Smith PM (1995) Diagnosis of infection by frozen section during revision arthroplasty. J Bone Joint Surg Br 77:28–33

    CAS  PubMed  Google Scholar 

  26. Takigami I, Itokazu M, Itoh Y, Matsumoto K, Yamamoto T, Shimizu K (2008) Limb-length measurement in total hip arthroplasty using a calipers dual pin retractor. Bull NYU Hosp Jt Dis 66:107–110

    PubMed  Google Scholar 

  27. Itokazu M, Matsunaga T, Ishii M, Kusakabe H, Wyni Y (1996) Use of arthroscopy and interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures. Arch Orthop Trauma Surg 115:45–48

    Article  CAS  PubMed  Google Scholar 

  28. Shinto Y, Uchida A, Korkusuz F, Araki N, Ono K (1992) Calcium hydroxyapatite ceramic used as a delivery system for antibiotics. J Bone Joint Surg Br 74:600–604

    CAS  PubMed  Google Scholar 

  29. Kawanabe K, Okada Y, Matsusue Y, Iida H, Nakamura T (1998) Treatment of osteomyelitis with antibiotic-soaked porous glass ceramic. J Bone Joint Surg Br 80:527–530

    Article  CAS  PubMed  Google Scholar 

  30. Tomford WW, Thongphasuk J, Mankin HJ, Ferraro MJ (1990) Frozen musculoskeletal allografts. A study of the clinical incidence and causes of infection associated with their use. J Bone Joint Surg Am 72:1137–1143

    CAS  PubMed  Google Scholar 

  31. Tanaka C, Shikata J, Ikenaga M, Takahashi M (2003) Acetabular reconstruction using a Kerboull-type acetabular reinforcement device and hydroxyapatite granules: a 3- to 8-year follow-up study. J Arthroplasty 18:719–725

    Article  PubMed  Google Scholar 

  32. Oonishi H, Iwaki Y, Kin N, Kushitani S, Murata N, Wakitani S, Imoto K (1997) Hydroxyapatite in revision of total hip replacements with massive acetabular defects: 4- to 10-year clinical results. J Bone Joint Surg Br 79:87–92

    Article  CAS  PubMed  Google Scholar 

  33. Sudo A, Hasegawa M, Fukuda A, Kawamura G, Muraki M, Uchida A (2007) Acetabular reconstruction using a cementless cup and hydroxyapatite granules: 3- to 8-year clinical results. J Arthroplasty 22:828–832

    Article  PubMed  Google Scholar 

  34. Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC, Chang JD, Kim SY, Kim YH (2001) Impregnation of vancomycin, gentamicin, and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty 16:882–892

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Iori Takigami, Yoshiki Ito, Daichi Ishimaru, Hiroyasu Ogawa, Nobuyuki Mori, Takashi Shimizu, Nobuo Terabayashi & Katsuji Shimizu

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  1. Iori Takigami
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  2. Yoshiki Ito
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  3. Daichi Ishimaru
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  4. Hiroyasu Ogawa
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  5. Nobuyuki Mori
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  6. Takashi Shimizu
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  7. Nobuo Terabayashi
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  8. Katsuji Shimizu
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Correspondence to Iori Takigami.

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Takigami, I., Ito, Y., Ishimaru, D. et al. Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks. Arch Orthop Trauma Surg 130, 1221–1226 (2010). https://doi.org/10.1007/s00402-009-0991-9

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  • DOI: https://doi.org/10.1007/s00402-009-0991-9

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