title: Clinical utility of antibiotic-loaded hydroxyapatite block for treatment of intractable periprosthetic joint infection and septic arthritis of the hip.
abstract: OBJECTIVE
  Antibiotic-loaded hydroxyapatite block (AHAB) allows gradual release of antibiotics for long duration without thermal damage and, therefore, is potentially a more effective antibacterial spacer than antibiotic-loaded polymethylmethacrylate cement (ALAC). The purposes of this study are to assess the utility of AHAB for the treatment of periprosthetic joint infection (PJI) or septic arthritis (SA) of the hip and to assess the potency of AHAB and ALAC in vitro.
  
  
  METHODS
  AHAB was utilized in two-stage reconstruction surgery for 20 PJI and 7 SA patients. Clinical success was confirmed if the patients did not show any sign of recurrence of infection during the follow-up period. Duration and amount of active vancomycin (VCM) released from AHAB and ALAC spacer were investigated in vitro.
  
  
  RESULTS
  Two-stage reconstruction using AHAB significantly improved hip function and showed 100% clinical success with mean follow-up of 37 months. The in vitro duration of the active effect of VCM released from AHAB (21 days) was longer than that from ALAC (7 days) and the amount of active VCM released from AHAB was higher than that from ALAC.
  
  
  CONCLUSIONS
  AHAB promises to release higher amounts of active VCM for longer durations than ALAC; therefore, it is a promising treatment for intractable PJI or SA.
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Hyonmin
authors: H
authors: Choe
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Yutaka
authors: Y
authors: Inaba
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Naomi
authors: N
authors: Kobayashi
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Yushi
authors: Y
authors: Miyamae
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Hiroyuki
authors: H
authors: Ike
authors: a Department of Orthopaedic Surgery , Yokohama City University , Yokohama , Japan.
authors: Tomoyuki
authors: T
authors: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000188:drug therapy*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements / Q000627:therapeutic use*; D017886:Durapatite / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000188:drug therapy*; D012086:Reoperation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D017886:Durapatite
keywords: Hydroxyapatite block; Periprosthetic joint infection; Septic arthritis; Spacer; Two-stage revision