Periprosthetic infection is becoming more and more common and devastating.Better treatment modality of two staged antibiotic cement spacer is becoming more and more common with excellent results.Antibiotic Cement Spacer for Infected Hip Joint Replacement (THR) Surgery, Dr.Sandeep Agrawal,Agrasen Hospital,Gondia,Maharashtra,India
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Antibiotic Cement Spacer for Infected Hip Joint Replacement (THR) Surgery, Dr.Sandeep Agrawal,Agrasen Hospital,Gondia,Maharashtra,India
1. Management of Infected Hip (THR)
joint Replacement Surgery by Hand
Made Antibiotic Cement Spacer
Dr.Sandeep Agrawal
MS . DNB
Agrasen Hospital
Gondia
Maharashtra India
ANTIBIOTIC
CEMENT
SPACER
10. Treatment Algorithm for Management of the infected THA
Depth of
infection
Wound
debridement/
antibiotics
Debilitated
patient
“Prosthesis retention
with debridement”(2)
Intravenous
antibiotics
Reinsertion of
another
prosthesis
Remove implant
Symptom
onset
Well-fixed
implant
Chronic oral
antibiotic
suppression
chronic
Poor soft-tissue envelope
Recalcitrant infection
Poor medical condition
superficial yes
yes
failure
Resection
arthroplasty(3)
deep no acute
failure
no yes
no
failure
AAOS ADVANCED RECONSTRUCTION HIP P.234 2005
11. ► Medically infirm patients
► Low virulent pathogen
► Oral antibiotics available
► Tolerable long-term antibiotics
► Prosthesis removal is not feasible and
no loose
1…Antibiotic suppression
12. ► Very strict criteria :
▪ Symptoms< 3 weeks
▪ Stable prosthesis
▪ No discharging sinus
▪ Susceptible pathogen
► Success rate: 50-70%
► Acceptable early successful rate but also
high recurrence Trampuz A et al, 2005
2…Debrideemnt with prosthesis retention
13. ► Remove prosthesis:
Girdlestone procedure over
hip joint
► High success rate
► Poor functional status
► For the very debilitated
3..Resection Arthroplasty
16. Dose of antibiotics
► Elution of antibiotics from the PROSTALAC is
effective when at least
!
3.6 g tobramycin
and 1g vancomycin were added
!
!
Masri et al 1998, J Arthroplasty
21. ► Selected patients
▪ Low- virulent organisms
▪ Identify organism before operation
▪ No sinus tract
▪ No major bone loss
▪ Antibiotic-loaded cement fixation
► More popular in Europe
► Success rate: 73%-92% (OKU 8)
!
► Hope et al, 1989
► Ure et al, 1998
Raut et al, 1994
4..One-stage revision arthroplasty
24. Antibiotic-cement spacer is not new
► Zilkens et al, 1990
► Ivarsson et al, 1994
► Leunig et al, 1998
► Deshmukh et al, 1998
► Younger et al, 1998
► Magnan et al, 2001
•Small series
•Hand-made prosthesis
•Hemiarthroplasty-like
42. ► Antibiotic elution from cement:
biphasic; high initially followed by sustained
release for months
Duncan et al, 1994 JBJS-A
► Antibiotic elution from cement spacer:
similar pattern
Minelli et al, 2004 JAC
43.
44.
45.
46. ► Most reliable method
► High success rate: 88-100% (OKU 8)
► Better functional result after revision hip
reconstruction procedure
Two-stage revision arthroplasty
47. Conclusions
► Remove prosthesis is mandatory when
face a infective hip arthroplasty
► 1.Debride alone: a very limited indication
► 2.One-stage revision: selected cases
► 3.Two-stage revision: most reliable and
effective
► With a cement spacer prosthesis: simple,
safe, effective, and versatile