Vancomycin-Gentamicin Prefabricated Spacers in 2-Stage Revision Arthroplasty for Chronic Hip and Knee Periprosthetic Joint Infection: Insights Into Reimplantation Microbiology and Outcomes |
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| Institution: | 1. Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain;2. Infectious Diseases Department, Vall d''Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain;3. Microbology Department, Vall d''Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain;4. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d''Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain;1. Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ;2. Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA;3. Department of Biostatistics, Mayo Clinic, Phoenix, AZ;4. Department of Surgery, Mayo Clinic, Phoenix, AZ;1. Department of Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland;2. Department of Biostatistics, University of Helsinki, Helsinki, Finland;3. Coxa Hospital for Joint Replacement, Tampere, Finland;4. National Institute for Health and Welfare, Helsinki, Finland;5. Department of Orthopaedics and Traumatology, Oulu University Hospital, Oulu, Finland;6. Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland;7. Orton Hospital, Helsinki, Finland;1. Department of Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom;2. Department of Orthopaedic Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada;1. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan;2. Department of Rehabilitation, Kansai University of Welfare and Sciences, Kashiwara, Osaka, Japan |
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| Abstract: | BackgroundSecond-stage positive cultures in 2-stage revision arthroplasty are a matter of concern, as their influence in outcomes is not clearly defined. We sought to study reimplantation microbiology when using vancomycin-gentamicin prefabricated cement spacers in hip and knee periprosthetic joint infection. The associations of second-stage positive cultures with treatment failures and patient-associated factors were analyzed.MethodsWe conducted a retrospective cohort study, examining patients managed with 2-stage revision arthroplasty due to knee or hip chronic periprosthetic joint infection between 2010 and 2017. Prefabricated vancomycin-gentamicin cement spacers were used during the spacer stage. Intraoperative microbiological culture results after the first and second stages were evaluated. The primary end point was infection eradication or relapse.ResultsA total of 108 cases were included (61 hips and 47 knees). And 22.2% of patients had ≥1 second-stage positive culture, while 9.3% had ≥2 positive samples. Overall success, at an average follow-up of 46.4 months, was 77.8%. Treatment failure was higher among cases with positive cultures (15.5% vs 45.8%, P < .01) regardless of the number of positive samples. Diabetes was identified as a risk factor for second-stage positive cultures (P = .03); use of cement loaded with extra antibiotics for spacer fixation showed a protective effect (P < .01).ConclusionSecond-stage positive cultures were related to a higher failure rate when using vancomycin-gentamicin cement spacers. Diabetes increased the likelihood of second-stage positive cultures. The use of extra-antibiotic-loaded cement for spacer fixation during the first stage showed a protective effect. |
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| Keywords: | vancomycin-gentamicin spacers second-stage positive cultures antibiotic-loaded cement periprosthetic joint infection two-stage revision arthroplasty |
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