The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 24; no. 10; pp. 3122 - 3130
• Main Authors: Drexler, Michael, Dwyer, Tim, Kuzyk, Paul R. T., Kosashvilli, Yona, Abolghasemian, Mansour, Regev, Gilad J., Kadar, Assaf, Rutenberg, Tal Frenkel, Backstein, David
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibiotics; Arthroplasty, Replacement, Knee - adverse effects; Bacteria; Bone Cements; Ceftazidime - administration & dosage; Female; Gram-negative bacteria; Humans; Infections; Joint replacement surgery; Knee; Knee Prosthesis - adverse effects; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Patients; Polymethyl methacrylate; Prosthesis-Related Infections - classification; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - therapy; Reoperation - methods; Retrospective Studies; Success; Transplants & implants; Vancomycin - administration & dosage; Tel Aviv Israel; Israel; Two-stage revision TKA; Impregnated cement spacers; Ceftazidime–Vancomycin
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-015-3753-y

Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought. Results The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision ( p  < 0.01), polymicrobial infections ( p  = 0.035), and infections presenting <6 months after index surgery ( p  = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index. Conclusion The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.