Abstract
Introduction: Two-stage revision procedure is the gold standard in management of periprosthetic joint infections. Cement spacers have long been used to preserve the space created during resection procedure and to release antiobiotics within the created dead space. However, the problems related to cement as an antibiotic carrier are well recognised (thermal necrosis, random porosity, unspecified antibiotic delivery rate).
Purpose: To present the concept of using PerOssal as a canal filling spacer and local antibiotic delivery system in two-stage revisions of hip and knee infected arthroplasty.
Material & Methods: 8 patients (6 females, 2 males) with infected arthroplasty (4 TKRs, 4 THRs) were managed with two-stage revision procedures during the years 2006–2008 (minimum FU: 12 months). Our protocol consisted of:
-
Preoperative determination of the causative organism its sensitivity to antibiotics
-
Radical debridement surgery and cement spacer with PerOssal implantation
-
Appropriate IV antibiotic therapy for 6 weeks and postoperative clinical evaluation and monitoring of inflammation markers
-
After a six-week antibiotic free interval and if inflammation markers had return to normal second stage surgery took place: Medullary canal reaming, intraoperative cultures, thorough wound irrigation with 10L NS and prosthesis implantation
-
Postoperative antibiotic therapy until culture results; IV antibiotic treatment for 6 more weeks if they were positive.
-
FU evaluation at 3, 6, 12, and 24 months.
Results: We had 7 cases with eradication of infection, 2 with delayed wound closure, and 1 late recurrence of disease.
Conclusion: We think that PerOssal can offer a very useful additional and genuine support in managing infected joint arthroplasties with so far good clinical results with respect to infection control.
Correspondence should be addressed to Vienna Medical Academy, Alser Strasse 4, A-1090 Vienna, Austria. Phone: +43 1 4051383 0, Fax: +43 1 4078274, Email: ebjis2009@medacad.org
