title: Vancomycin-supplemented impacted bone allografts in infected hip arthroplasty. Two-stage revision results.
abstract: Bone allografts can store and release high levels of vancomycin. We present our results of a two-stage treatment for infected hip arthroplasty with acetabular and femoral impaction grafting using vancomycin-loaded allografts. We treated 29 patients (30 hips) by removal of the implants, meticulous debridement, parenteral antibiotic therapy and second-stage reconstruction using vancomycin-supplemented impacted bone allografts and a standard, cemented Charnley femoral component. The mean follow-up was 32.4 months (24 to 60). Infection control was obtained in 29 cases (re-infection rate of 3.3%; 95% confidence interval 0.08 to 17) without evidence of progressive radiolucent lines, demarcation or graft resorption. One patient had a further infection ten months after revision caused by a different pathogen. Associated post-operative complications were one traumatic periprosthetic fracture at 14 months, a single dislocation in two hips and four displacements of the greater trochanter. Vancomycin-supplemented allografts restored bone stock and provided sound fixation with a low incidence of further infection.
authors.affiliation: The Hip Surgery Unit, Institute of Orthopaedics Carlos E. Ottolenghi Italian Hospital, Buenos Aires, Argentina. cadera@hospitalitaliano.org.ar
authors.forename: M A
authors.initials: MA
authors.lastname: Buttaro
authors.forename: R
authors.initials: R
authors.lastname: Pusso
authors.forename: F
authors.initials: F
authors.lastname: Piccaluga
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001168:Arthritis / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D025981:Hip Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011859:Radiography; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D014640:Vancomycin / Q000008:administration & dosage*
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin