Limits...
Treatment failure among infected periprosthetic total hip arthroplasty patients.

Schwarzkopf R, Mikhael B, Wright E, Estok DM, Katz JN - Open Orthop J (2014)

Bottom Line: We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure.We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision.We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA.

ABSTRACT
Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure. We defined "eradication of infection" on the basis of negative cultures and clinical diagnosis at least one year after 2(nd) stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.

No MeSH data available.


Related in: MedlinePlus

A femoral modular stem is placed into the cement mold.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4066371&req=5

Figure 3: A femoral modular stem is placed into the cement mold.

Mentions: To conserve surgical time, we simultaneously fabricated the cement-tapered stem on the back table. Our specialized stem mold was used to produce the antibiotic femoral stem by coating a modular stem (S-ROM, Depuy, Warsw). The femoral head spacer was fabricated by covering a 22 mm CoCr head with a cement-molded spacer (fabricated from a surgical irrigation bulb syringe). Our protocol includes 80 grams (two packs) of polymethylmethacrylate cement (Simplex P; Stryker, Mahwah, NJ), premixed with 1 gram of tobramycin per 40 grams of cement. To this we added 4.8 grams of tobramycin powder, and 2 grams of vancomycin powder for a total of 4.4 grams of antibiotics per 40 grams of cement powder. For mixing we added a third bottle of monomer due to the added volume of the antibiotics. The cement was mixed and poured into the appropriate size tapered stem mold and bulb syringe mold (Fig. 2A, b). A femoral modular stemwas placed into the cement mold (Fig. 3), and a femoral head was placed into the syringe mold (Fig. 4). After full polymerization of the cement, the mold and bulb syringe were split and the stem and head were removed (Fig. 5A, b). The stem was placed appropriately into the femoral canal (Fig. 6). The hip was reduced and stability examined. After verification of desired anteversion angle the spacer was secured by adding cement into the medial calcar flare and coating the exposed body of the implant to provide adequate rotational stability. The added cement protocol included 40 grams (one pack) of polymethylmethacrylate cement (Palacos R+G; Zimmer, Warsaw, IN), premixed with 0.5 gram of gentamycin per 40 grams of cement. To this we added 2.4 grams of tobramycin powder, and 1 gram of vancomycin powder for a total of 3.9 grams of antibiotics per 40 grams of cement powder. The decision to use two different cements for each phase of the surgery is due to their different work time, Simplex is more liquid and easier to pour into the mold, and Palacos has more work time and easier to use for “free hand” molding.


Treatment failure among infected periprosthetic total hip arthroplasty patients.

Schwarzkopf R, Mikhael B, Wright E, Estok DM, Katz JN - Open Orthop J (2014)

A femoral modular stem is placed into the cement mold.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066371&req=5

Figure 3: A femoral modular stem is placed into the cement mold.
Mentions: To conserve surgical time, we simultaneously fabricated the cement-tapered stem on the back table. Our specialized stem mold was used to produce the antibiotic femoral stem by coating a modular stem (S-ROM, Depuy, Warsw). The femoral head spacer was fabricated by covering a 22 mm CoCr head with a cement-molded spacer (fabricated from a surgical irrigation bulb syringe). Our protocol includes 80 grams (two packs) of polymethylmethacrylate cement (Simplex P; Stryker, Mahwah, NJ), premixed with 1 gram of tobramycin per 40 grams of cement. To this we added 4.8 grams of tobramycin powder, and 2 grams of vancomycin powder for a total of 4.4 grams of antibiotics per 40 grams of cement powder. For mixing we added a third bottle of monomer due to the added volume of the antibiotics. The cement was mixed and poured into the appropriate size tapered stem mold and bulb syringe mold (Fig. 2A, b). A femoral modular stemwas placed into the cement mold (Fig. 3), and a femoral head was placed into the syringe mold (Fig. 4). After full polymerization of the cement, the mold and bulb syringe were split and the stem and head were removed (Fig. 5A, b). The stem was placed appropriately into the femoral canal (Fig. 6). The hip was reduced and stability examined. After verification of desired anteversion angle the spacer was secured by adding cement into the medial calcar flare and coating the exposed body of the implant to provide adequate rotational stability. The added cement protocol included 40 grams (one pack) of polymethylmethacrylate cement (Palacos R+G; Zimmer, Warsaw, IN), premixed with 0.5 gram of gentamycin per 40 grams of cement. To this we added 2.4 grams of tobramycin powder, and 1 gram of vancomycin powder for a total of 3.9 grams of antibiotics per 40 grams of cement powder. The decision to use two different cements for each phase of the surgery is due to their different work time, Simplex is more liquid and easier to pour into the mold, and Palacos has more work time and easier to use for “free hand” molding.

Bottom Line: We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure.We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision.We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics Surgery, University of California Irvine, 101 The City Drive South, Orange, CA 92868, USA.

ABSTRACT
Two-stage revision has been shown to be the most successful treatment in eradicating deep infection following total hiparthroplasty. We identified 62 patients treated by a two-stage revision. We defined "successful revision" as negative intraoperative cultures and no further infection-related procedure. We defined "eradication of infection" on the basis of negative cultures and clinical diagnosis at least one year after 2(nd) stage procedure. After a mean follow up of 2.7 years, eradication of the infection was documented in 91.1%, and a successful two-stage revision in 85.7% of patients. We observed no association between higher pre-reimplantation levels of ESR and C-reactive protein and lower likelihood of successful two-stage revision. We found an association between a history of another previous infected prosthetic joint and a failed 2(nd) stage procedure. Failure to achieve eradication of infection and successful two-stage revision occurs infrequently. Patients with prior history of a previous prosthetic joint infection are at higher risk of failure.

No MeSH data available.


Related in: MedlinePlus