Low-dose vancomycin-loaded cement spacer for two-stage revision of infected total hip arthroplasty
Ömür Çağlar1, Mazhar Tokgözoğlu1, Rahmi C. Akgün2, Bülent Atilla1
1Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
2Department of Orthopedics and Traumatology, Başkent University Faculty of Medicine, Ankara, Turkey
Keywords: Antibiotic-loaded cement spacer, periprosthetic infection of the hip, two-stage revision, vancomycin.
Objectives: This study aims to evaluate the success rate in terms of eradication of infection and long-term outcomes of two- stage revision arthroplasty with spacers loaded with low-dose vancomycin alone for the treatment of an infected hip arthroplasty.
Patients and methods: The records of 42 two-stage exchange arthroplasty patients (16 males, 26 females; mean age 61 years; range, 30 to 80 years) treated between January 1999 and January 2009 were included in this retrospective study. In the first stage, following removal of the prosthesis and debridement, a spacer consisting of 1 g of vancomycin per 40 g of cement was placed in the infected joint space. Patients received six weeks of intravenous antibiotics according to intraoperative cultures. After cessation of systemic antibiotic treatment, with normal C-reactive protein and erythrocyte sedimentation rate levels, second stage surgery with cementless components was performed.
Results: The mean follow-up duration was seven (range, 3 to 13) years. Two patients (4.7%) developed re-infection after two-stage reimplantation and one patient underwent a resection arthroplasty after repeated debridements. Five years of survival was 92.9% with Kaplan-Meier survival analysis.
Conclusion: For chronic infected total hip revisions, two-stage revision arthroplasty with low-dose vancomycin impregnated cement spacers have comparable re-infection and success rates. Low-dose vancomycin promotes effective infection control and reduces antibiotic toxicity.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.