Abstract
Introduction
Periprosthetic infection is a serious complication after total hip arthroplasty (THA). Two stage procedure using antibiotic-impregnated cement spacer is one of the treatments for late chronic infection after THA. We investigated the effects of two stage procedure on the infection control and the recurrence of infection after revision THA.
Materials and Methods
We retrospectively reviewed a consecutive series of 10 cases of a periprosthetic infection after hip arthroplasty, including 3 THA and 7 bipolar hemiarthroplasty (BHA). They were treated with two stage procedure using antibiotic-impregnated cement spacer from 2004 to 2009. There were 4 women and 6 men with an average age of 68.4 years. The pathogens were methicilin-resistant Staphylococcus aureus (MRSA) in 3 cases, coagulase-negative Staphylococcus (CNS) in 2 cases, Enterococcus in 2 cases, Streptococcus in 2 cases, and unknown in 1 case.
After removal of the prosthesis, extensive debridement was performed to remove infected tissues and residual cement. After irrigation with iodine solution, antibiotic-impregnated cement spacer was inserted with proximal cement fixation to prevent dislocation and fracture of the cement spacer. The antibiotics that were impregnated in the cement spacer were VCM in 8 cases, MEPM in 1 case, and CAZ in 1 case. Intravenous antibiotics were administrated for 3 weeks after this first stage surgery, and then oral antibiotics were administrated until C-reactive protein (CRP) rates became negative. After confirming the culture of joint fluid contained no pathogens, second stage revision surgery was performed. The average follow-up period after revision THA was 2.3 years.
We investigated the period from first stage surgery to the day when CRP became negative, and to the day of second stage surgery. The incidence of recurrence of infection after revision THA was investigated.
Results
The average period to negative CRP was 25 days, and that to the second stage surgery was 64 days. There has been no recurrent infection until now.
Discussion
The antibiotics-impregnated cement spacer for the treatment of periprosthetic infection was introduced around 1990, and success rate of this technique was reported to exceed 90%. In our series, we experienced no recurrence of infection in spite of containing 3 MRSA cases and 2 CNS cases. The advantages of the antibiotics-impregnated cement spacer were to avoid soft tissue shortening and to allow patient to walk without weight bearing. We concluded that two-stage revision technique with antibiotics-impregnated cement spacer is an effective treatment for peripros
