Acute Delayed or Late Infection of Revision Total Hip Arthroplasty Treated with Debridement/Antibiotic-loaded Cement Beads and Retention of the Prosthesis / 대한고관절학회지

PURPOSE: The treatment of infected revision total hip arthroplasty (THA) is very challenging due to retained revision prosthesis, poor bone stock and soft tissue condition derived from previous revision surgeries, and comorbidities. The purpose of this study was to investigate the effectiveness and short-term outcomes of aggressive debridement and use of antibiotic-loaded cement beads with retention of the prosthesis for acute delayed or late infection of revision THAs. MATERIALS AND METHODS: Ten consecutive patients with symptoms or signs of less than one-week evolution and well-fixed prostheses, were treated with this procedure and a postoperative course of organism-specific antibiotics for a minimum of 6 weeks. All hips presented with acute delayed or late infection of revision THAs. Patients with a mean age of 68.1 years (range, 59-78 years) underwent an average of 1.9 previous revision THAs (1-4) before the index surgery. The minimal follow-up was 2 years with a mean of 46.2 months (range, 24-64 months). RESULTS: There were 8 cures (80.0%) and 2 failures with no mortality during the study period. The 2 failures involved the same and resistant bacteria implicated in the primary infection (methicillin-resistant Staphylococcus aureus and Prevotella oralis, respectively). The mean Harris hip score was 65.2 (range, 26-83) and the mean visual analogue scale was 2.6 (range, 1-4) at final follow-up. CONCLUSION: With a favorable success rate and no mortality, our procedure may be considered a safe and effective alternative for the treatment of acute delayed or late infection of revision THAs with well-fixed prostheses.

Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement

PURPOSE: To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty. MATERIALS AND METHODS: Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted. RESULTS: After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion. CONCLUSION: Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.

Spinal Epidural Abscess with Pyogenic Arthritis of Facet Joint Treated with Antibiotic-Bone Cement Beads: A Case Report

Most epidural abscesses are a secondary lesion of pyogenic spondylodiscitis. An epidural abscess associated with pyogenic arthritis of the facet joint is quite rare. To the best of our knowledge, there is no report of the use of antibiotic-cement beads in the surgical treatment of an epidural abscess. This paper reports a 63-year-old male who sustained a 1-week history of radiating pain to both lower extremities combined with lower back pain. MRI revealed space-occupying lesions, which were located in both sides of the anterior epidural space of L4, and CT scans showed irregular widening and bony erosion of the facet joints of L4-5. A staphylococcal infection was identified after a posterior decompression and an open drainage. Antibiotic- bone cement beads were used as a local controller of the infection and as a spacer or an indicator for the second operation. An intravenous injection of anti-staphylococcal antibiotics resolved the back pain and radicular pain and normalized the laboratory findings. We point out not only the association of an epidural abscess with facet joint infection, but also the possible indication of antibiotic-bone cement beads in the treatment of epidural abscesses.

Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회잡지

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.