title: Superficial Vancomycin Coating of Bone Cement in Orthopedic Revision Surgery: A Safe Technique to Enhance Local Antibiotic Concentrations.
abstract: The use of antibiotic-loaded cement has become a well-accepted method to develop high local antibiotic concentrations in revision surgery of infected arthroplasty. A new surgical technique has been established to further increase the local antibiotic concentration and thereby minimizes the risk of reinfection. Our study aim was to investigate the safety of additional superficial vancomycin coating (SVC) by analyzing postoperative joint and serum vancomycin concentrations, as well as the creatinine levels of patients with orthopedic revision surgery.
  
  
  
  A longitudinal case series was performed by reviewing collected data of patients who were treated by SVC during revision surgery (1- or 2-stage exchange) because of prosthetic joint infections. Vancomycin levels were obtained, local from drains and systemic from blood samples, on postoperative days 1 to 5. Furthermore, preoperative and postoperative serum creatinine levels were analyzed.
  
  
  
  Highest median local vancomycin levels were documented on postoperative day 1 with 546.8 μg/mL (range, 44.4-1485 μg/mL) in the reimplantation group and 408.7 μg/mL (range, 24.7-1650 μg/mL) in the spacer group. Median serum vancomycin level was 4.4 μg/mL (range, <2.0-11.7 μg/mL) on the first postoperative day in the reimplantation group and <2.0 μg/mL (range, <2.0-3.9 μg/mL) in the spacer group, and lower than 2.0 μg/mL (range, <2.0-7.5 μg/mL) from postoperative day 2 to 5 in both groups. Neither an anaphylactic reaction nor other side effects to SVC were observed.
  
  
  
  Our data showed that SVC of bone cement is an effective technique to enhance local concentrations of vancomycin without leading to systemic side effects.
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Amerstorfer
authors.affiliation: Department of Trauma Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Fischerauer
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Sadoghi
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria.
authors.forename: Gerold
authors.initials: G
authors.lastname: Schwantzer
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Klaus Dieter
authors.initials: KD
authors.lastname: Kuehn
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Leithner
authors.affiliation: Department of Orthopedic Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Mathias
authors.initials: M
authors.lastname: Glehr
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000032:analysis; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001774:Blood Chemical Analysis; D001843:Bone Cements; D005260:Female; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011208:Powders; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D013582:Synovial Fluid / Q000737:chemistry; D014640:Vancomycin / Q000008:administration & dosage* / Q000032:analysis
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D005839:Gentamicins; D011208:Powders; D014640:Vancomycin
keywords: cement; coating; revision; superficial; surgery; vancomycin