title: Industrially prefabricated cement spacers: do vancomycin- and gentamicin-impregnated spacers offer any advantage?
abstract: BACKGROUND
  Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known.
  
  
  OBJECTIVE
  We therefore sought to compare industrially prefabricated spacers containing either gentamicin or gentamicin and vancomycin with respect to (1) infection control, (2) complications, and (3) quality of life, pain, and patient satisfaction.
  
  
  METHODS
  We performed a review of 51 patients with chronic infections treated at one center using either gentamicin or vancomycin and gentamicin-prefabricated spacers. The former were used exclusively from January 2006 until May 2009, and the latter from June 2009 until July 2011, and there was no overlap. We collected data on demographics, immunologic status (McPherson classification), prosthetic joint infection location, type of prosthesis, microbiologic results, and time between stages. We evaluated the primary outcome of infection control or recurrence after at least 12 months followup. We also recorded complications. Each patient completed a quality-of-life survey, VAS, and a self-administered satisfaction scale.
  
  
  RESULTS
  The overall infection control rate was 83% after a mean followup of 35 months (range, 12.4-64.7 months). There were no differences between gentamicin and vancomycin and gentamicin spacers in terms of infection eradication (80 % versus 85 %, respectively; p = 0.73), nor in terms of complications, quality of life, pain, or satisfaction scores.
  
  
  CONCLUSIONS
  Prefabricated, antibiotic-loaded cement spacers has been proven effective for infection control in TKAs and THAs but with the numbers available, we did not find any differences between a gentamicin or vancomycin and gentamicin-prefabricated spacer, and therefore, we are unable to validate the superiority of the combination of vancomycin and gentamicin over gentamicin alone. Because of the higher costs involved with vancomycin and gentamicin spacers, and the potential risks of unselective use of vancomycin, further comparative studies are necessary to evaluate their role in the treatment of infected THAs or TKAs.
  
  
  METHODS
  Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain, pcorona@vhebron.net.
authors.forename: Pablo S
authors.initials: PS
authors.lastname: Corona
authors.forename: Victor
authors.initials: V
authors.lastname: Barro
authors.forename: Marye
authors.initials: M
authors.lastname: Mendez
authors.forename: Enric
authors.initials: E
authors.lastname: Cáceres
authors.forename: Xavier
authors.initials: X
authors.lastname: Flores
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000295:instrumentation; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D020099:Coated Materials, Biocompatible; D020878:Device Removal; D005260:Female; D005839:Gentamicins / Q000009:adverse effects / Q000627:therapeutic use*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology; D017060:Patient Satisfaction; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014640:Vancomycin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D005839:Gentamicins; D014640:Vancomycin