Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty

• Published in: Joint diseases and related surgery Vol. 31; no. 3; pp. 449 - 455
• Main Authors: Çağlar, Ömür, Tokgözoğlu, Mazhar, Akgün, Rahmi C, Atilla, Bülent
• Format: Journal Article
• Language: English
• Published: Turkey Bayçınar Medical Publishing 01.01.2020
• Subjects: Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; Arthritis, Infectious - drug therapy; Arthritis, Infectious - etiology; Arthritis, Infectious - surgery; Arthroplasty, Replacement, Hip - adverse effects; Bone Cements - therapeutic use; Device Removal - methods; Dosage Forms; Female; Humans; Infusion Pumps, Implantable; Male; Middle Aged; Original; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Reoperation - adverse effects; Reoperation - methods; Treatment Outcome; Vancomycin - administration & dosage; Vancomycin - adverse effects
• ISSN: 2687-4784; 2687-4792
• DOI: 10.5606/ehc.2020.76108

This study aims to evaluate the success rate in terms of eradication of infection and long-term outcomes of two- stage revision arthroplasty with spacers loaded with low-dose vancomycin alone for the treatment of an infected hip arthroplasty. The records of 42 two-stage exchange arthroplasty patients (16 males, 26 females; mean age 61 years; range, 30 to 80 years) treated between January 1999 and January 2009 were included in this retrospective study. In the first stage, following removal of the prosthesis and debridement, a spacer consisting of 1 g of vancomycin per 40 g of cement was placed in the infected joint space. Patients received six weeks of intravenous antibiotics according to intraoperative cultures. After cessation of systemic antibiotic treatment, with normal C-reactive protein and erythrocyte sedimentation rate levels, second stage surgery with cementless components was performed. The mean follow-up duration was seven (range, 3 to 13) years. Two patients (4.7%) developed re-infection after two-stage reimplantation and one patient underwent a resection arthroplasty after repeated debridements. Five years of survival was 92.9% with Kaplan-Meier survival analysis. For chronic infected total hip revisions, two-stage revision arthroplasty with low-dose vancomycin impregnated cement spacers have comparable re-infection and success rates. Low-dose vancomycin promotes effective infection control and reduces antibiotic toxicity.