Professional Documents
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Agrasen Hospital
Gondia
Maharashtra India
ANTIBIOTIC
CEMENT
SPACER
Clinical Challenges
Common Pathogens
Biofilm
Clinical Diagnosis
No Single Test
Treatment choices
Debilitated
patient
deep
superficial
no
Symptom
onset
acute
Prosthesis retention
with debridement(2)
yes
Chronic oral
antibiotic
Wound
debridement/
antibiotics
Well-fixed
implant
chronic
suppression
yes
failure
no
Intravenous
antibiotics
failure
Remove implant
Reinsertion of
another
prosthesis
no
failure
Resection
yes
arthroplasty(3)
1Antibiotic suppression
Symptoms< 3 weeks
Stable prosthesis
No discharging sinus
Susceptible pathogen
3..Resection Arthroplasty
Remove prosthesis:
Girdlestone procedure over
hip joint
High success rate
Poor functional status
For the very debilitated
Girdlestone Problems
Leg length inequality
Inability to bear weight
Disuse osteoporosis
Extensive scarring
Distorted tissue plane
Difficult reimplantation
Dose of antibiotics
3.6 g tobramycin
and 1g vancomycin were added
!
!
1994-1996
70 hips
M:F= 53:17
Age: 60 (34-85) y/o
Follow= 5.4 (2-8) yrs
Group B (Spacer)
1996-2000
58 hips
M:F=43:15
Age: 63 (28-81) y/o
Follow= 4.2 (2-6) yrs
Infection control
98%
95%
91%
87%
83%
79%
75%
72%
68%
64%
60%
94.3%
96.5%
Infection c
66/70
56/58
Group A
Group B
(P=0.69)
Ambulatory status
60
49
51
45
Beads
Spacer
30
87.5%
15
12
7
19.0%
0
Ambulatory
Non-ambulator
(P=0.001)
J-Trauma
Treatment Protocol
1st Stage :
Removal of all components, debridement
Antibiotic-cement spacer
Between Stages :
IV antibiotics (2 weeks)
+/- Oral antibiotics (4 weeks)
2nd Stage :
Normal CRP
Antibiotics in cement
ACETABULUM PREPARATION
Silicon Mould
ENDOSKELETON
ENDOSKELETON IN MOLD
Cement-on-cement
Proximal
cementation
Metal Rod as
endoskeleton
Temporary prosthesis
Local antibiotic delivery
Choice of antibiotics
Heat-stable
Powdered form
Broad spectrum
G(+): vancomycin, teicoplanin
G(-): tobramycin, piperacillin, aztreonam
Antibiotics: bone cement = 1: 5
Dislocation
Fracture
Dislocation
Fracture
similar pattern
Minelli et al, 2004 JAC
Conclusions
Remove prosthesis is mandatory when
face a infective hip arthroplasty
1.Debride alone: a very limited indication
Thanks To DR.HSIEH
Dr.Pang Hsieh
Taiwan