Skip to main content

Advertisement

SpringerLink
Log in

The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA).

Methods

A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought.

Results

The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision (p < 0.01), polymicrobial infections (p = 0.035), and infections presenting <6 months after index surgery (p = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index.

Conclusion

The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Azzam K, McHale K, Austin M, Purtill JJ, Parvizi J (2009) Outcome of a second two-stage reimplantation for periprosthetic knee infection. Clin Orthop Relat Res 467:1706–1714

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bradbury T, Fehring TK, Taunton M, Hanssen A, Azzam K, Parvizi J, Odum SM (2009) The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty 24:101–104

    Article  PubMed  Google Scholar 

  3. Brandt CM, Sistrunk WW, Duffy MC, Hanssen AD, Steckelberg JM, Ilstrup DM, Osmon DR (1997) Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis 24:914–919

    Article  CAS  PubMed  Google Scholar 

  4. Buchholz HW, Engelbrecht H (1970) Depot effects of various antibiotics mixed with Palacos resins. Chirurg 41:511–515

    CAS  PubMed  Google Scholar 

  5. Cha MS, Cho SH, Kim DH, Yoon HK, Cho HS, Lee DY, Lee SH, Hwang SC (2015) Two-stage total knee arthroplasty for prosthetic joint infection. Knee Surg Relat Res. 27(2):82–89

    Article  PubMed  PubMed Central  Google Scholar 

  6. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  PubMed  Google Scholar 

  7. Coventry MB (1975) Treatment of infections occurring in total hip surgery. Orthop Clin North Am 6:991–1003

    CAS  PubMed  Google Scholar 

  8. Curtis JM, Sternhagen V, Batts D (2005) Acute renal failure after placement of tobramycin-impregnated bone cement in an infected total knee arthroplasty. Pharmacotherapy 25(6):876–880

    Article  PubMed  Google Scholar 

  9. Dovas S, Liakopoulos V, Papatheodorou L, Chronopoulou I, Papavasiliou V, Atmatzidis E, Giannopoulou M, Eleftheriadis T, Simopoulou T, Karachalios T, Stefanidis I (2008) Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty. Clin Nephrol 69(3):207–212

    Article  CAS  PubMed  Google Scholar 

  10. Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br 90(7):874–878

    Article  CAS  PubMed  Google Scholar 

  11. Haleem AA, Berry DJ, Hanssen AD (2004) Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty. Clin Orthop Relat Res 428:35–39

    Article  PubMed  Google Scholar 

  12. Hebert CK, Williams RE, Levy RS, Barrack RL (1996) Cost of treating an infected total knee replacement. Clin Orthop Relat Res 331:140–145

    Article  PubMed  Google Scholar 

  13. Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ (2004) Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection. Biomaterials 25(3):545–556

    Article  CAS  PubMed  Google Scholar 

  14. Jamsen E, Huhtala H, Puolakka T, Moilanen T (2009) Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 91:38–47

    Article  PubMed  Google Scholar 

  15. Jiranek WA, Hanssen AD, Greenwald AS (2006) Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am 88:2487–2500

    Article  PubMed  Google Scholar 

  16. Joseph TN, Chen AL, Di Cesare PE (2003) Use of antibiotic impregnated cement in total joint arthroplasty. J Am Acad Orthop Surg 11(1):38–47

    Article  PubMed  Google Scholar 

  17. Kalra KP, Lin KK, Bozic KJ, Ries MD (2010) Repeat 2-stage revision for recurrent infection of total hip arthroplasty. J Arthroplasty 25:880–884

    Article  PubMed  Google Scholar 

  18. Kilgus DJ, Howe DJ, Strang A (2002) Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 404:116–124

    Article  PubMed  Google Scholar 

  19. Lindeque B, Hartman Z, Noshchenko A, Cruse M (2014) Infection after primary total hip arthroplasty. Orthopedics 37(4):257–265

    Article  PubMed  Google Scholar 

  20. Mahmud T, Lyons MC, Naudie DD, Macdonald SJ, McCalden RW (2012) Assessing the gold standard: a review of 253 two-stage revisions for infected TKA. Clin Orthop Relat Res 470:2730–2736

    Article  PubMed  PubMed Central  Google Scholar 

  21. Menge TJ, Koethe JR, Jenkins CA, Wright PW, Shinar AA, Miller GG, Holt GE (2012) Acute kidney injury after placement of an antibiotic-impregnated cement spacer during revision total knee arthroplasty. J Arthroplasty 27(6):1221–1227

    Article  PubMed  Google Scholar 

  22. Mirra JM, Amstutz HC, Matos M, Gold R (1976) The pathology of the joint tissues and its clinical relevance in prosthesis failure. Clin Orthop Relat Res 117:221–240

    PubMed  Google Scholar 

  23. Mortazavi SM, Vegari D, Ho A, Zmistowski B, Parvizi J (2011) Two-stage exchange arthroplasty for infected total knee arthroplasty: predictors of failure. Clin Orthop Relat Res 469(11):3049–3054

    Article  PubMed  PubMed Central  Google Scholar 

  24. Parvizi J, Adeli B, Zmistowski B, Restrepo C, Greenwald AS (2012) Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am 94:e104

    Article  PubMed  Google Scholar 

  25. Parvizi J, Saleh KJ, Ragland PS, Pour AE, Mont MA (2008) Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 79(3):335–341

    Article  PubMed  Google Scholar 

  26. Patrick BN, Rivey MP, Allington DR (2006) Acute renal failure associated with vancomycin- and tobramycin-laden cement in total hip arthroplasty. Ann Pharmacother 40(11):2037–2042

    Article  CAS  PubMed  Google Scholar 

  27. Pelt CE, Grijalva R, Anderson L, Anderson MB, Erickson J, Peters CL (2014) Two-stage revision TKA is associated with high complication and failure rates. Adv Orthop 2014:659047

    Article  PubMed  PubMed Central  Google Scholar 

  28. Salgado CD, Dash S, Cantey JR, Marculescu CE (2007) Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res 461:48–53

    PubMed  Google Scholar 

  29. Schwarzkopf R, Oh D, Wright E, Estok DM, Katz JN (2013) Treatment failure among infected periprosthetic patients at a highly specialized revision TKA referral practice. Open Orthop J 28(7):264–271

    Article  Google Scholar 

  30. Senthi S, Munro JT, Pitto RP (2011) Infection in total hip replacement: meta-analysis. Int Orthop 35:253–260

    Article  PubMed  Google Scholar 

  31. Sherrell JC, Fehring TK, Odum S, Hansen E, Zmistowski B, Dennos A, Kalore N (2011) The Chitranjan Ranawat Award: fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection. Clin Orthop Relat Res 469:18–25

    Article  PubMed  Google Scholar 

  32. Springer BD, Lee GC, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ (2004) Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res 427:47–51

    Article  PubMed  Google Scholar 

  33. Stammers J, Kahane S, Ranawat V, Miles J, Pollock R, Carrington RW, Briggs T, Skinner JA (2015) Outcomes of infected revision knee arthroplasty managed by two-stage revision in a tertiary referral centre. Knee 22(1):56–62

    Article  PubMed  Google Scholar 

  34. Sterling GJ, Crawford S, Potter JH, Koerbin G, Crawford R (2003) The pharmacokinetics of Simplex-tobramycin bone cement. J Bone Joint Surg Br 85:646–649

    CAS  PubMed  Google Scholar 

  35. Thabe H, Schill S (2007) Two-stage reimplantation with an application spacer and combined with delivery of antibiotics in the management of prosthetic joint infection. Oper Orthop Traumatol 19(1):78–100

    Article  PubMed  Google Scholar 

  36. Thornsberry C (1985) Review of in vitro activity of third-generation cephalosporins and other newer beta-lactam antibiotics against clinically important bacteria. Am J Med 79:14–20

    Article  CAS  PubMed  Google Scholar 

  37. Tigani D, Trisolino G, Fosco M, Ben Ayad R, Costigliola P (2013) Two-stage reimplantation for periprosthetic knee infection: influence of host health status and infecting microorganism. Knee 20(1):9–18

    Article  CAS  PubMed  Google Scholar 

  38. Trousdale RT, Hanssen AD (2001) Infection after total knee arthroplasty. Instr Course Lect 50:409–414

    CAS  PubMed  Google Scholar 

  39. 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 

  40. Westrich GH, Walcott-Sapp S, Bornstein LJ, Bostrom MP, Windsor RE, Brause BD (2010) Modern treatment of infected total knee arthroplasty with a 2-stage reimplantation protocol. J Arthroplasty 25(7):1015–1021

    Article  PubMed  Google Scholar 

  41. Winkler H (2009) Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft. Int J Med Sci 6(5):247–252

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Mount Sinai Hospital, 600 University Avenue, Toronto, ON, M5G 1X5, Canada

      Michael Drexler, Tim Dwyer, Paul R. T. Kuzyk, Yona Kosashvilli, Mansour Abolghasemian & David Backstein

    2. Tel-Aviv Sourasky Medical Center, Tel Aviv University, Waitzman 6 St, 6423906, Tel Aviv, Israel

      Gilad J. Regev, Assaf Kadar & Tal Frenkel Rutenberg

    Authors
    1. Michael Drexler
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Tim Dwyer
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Paul R. T. Kuzyk
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Yona Kosashvilli
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Mansour Abolghasemian
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Gilad J. Regev
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Assaf Kadar
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Tal Frenkel Rutenberg
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. David Backstein
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Michael Drexler.

    Additional information

    Michael Drexler and Tim Dwyer have contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Drexler, M., Dwyer, T., Kuzyk, P.R.T. et al. The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections. Knee Surg Sports Traumatol Arthrosc 24, 3122–3130 (2016). https://doi.org/10.1007/s00167-015-3753-y

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00167-015-3753-y

    Keywords

    Search

    Navigation