title: Two-stage revision total hip arthroplasty for periprosthetic infections using antibiotic-impregnated cement spacers of various types and materials.
abstract: Antibiotic-impregnated hip cement spacers of various types and materials have been used in the treatment of periprosthetic hip infections. We developed a handmade spacer by using polymethylmethacrylate (PMMA) and/or α -tricalcium phosphate ( α -TCP). In this study, we retrospectively reviewed the surgical outcomes in 36 consecutive patients treated with 2-stage revision total hip arthroplasty by using our antibiotic-impregnated hip cement spacers. We aimed to analyze the infection control and reinfection rates after revision surgery. Moreover, we analyzed the possible predictors of postoperative reinfection. After exclusion of 1 patient who died immediately after the first-stage surgery, infection was controlled in 33 of the 36 hips (success rate, 91.7%). Two of these 33 hips underwent resection arthroplasty. Of the 36 hips that had been treated with the antibiotic-cement spacer, 31 hips (86.1%) were eligible for the second-stage prosthesis re-implantation. The 31 protocol hip joints of patients followed up for >6 months (mean, 48.6 months). Ten of these 31 hips (32.3%) became reinfected. No possible predictor examined differed significantly between the reinfection-positive and reinfection-negative groups. However, spacers consisting of PMMA cement alone were associated with the highest risk of reinfection. Therefore, α -TCP-containing antibiotic-impregnated hip cement spacers might decrease the reinfection rate in patients undergoing re-implantation.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Uchiyama
authors.affiliation: School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan.
authors.forename: Naonobu
authors.initials: N
authors.lastname: Takahira
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Fukushima
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Moriya
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Yojiro
authors.initials: Y
authors.lastname: Minegishi
authors.affiliation: School of Allied Health Sciences, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan.
authors.forename: Rina
authors.initials: R
authors.lastname: Sakai
authors.affiliation: Kyushu Rosai Hospital, 1-1 Sonekitamachi, Kokuraminami-ku, Kitakyushu, Fukuoka 800-0229, Japan.
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Itoman
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D001843:Bone Cements; D002130:Calcium Phosphates / Q000737:chemistry; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000737:chemistry; D011183:Postoperative Complications; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000601:surgery*; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D002130:Calcium Phosphates; C485828:alpha-tricalcium phosphate; D019904:Polymethyl Methacrylate; C020243:calcium phosphate