Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2019

Open Access 01-12-2019 | Antibiotic | Research article

Does the use of a closed-suction drain reduce the effectiveness of an antibiotic-loaded spacer in two-stage exchange Arthroplasty for Periprosthetic hip infection? A prospective, randomized, controlled study

Authors: Chi Xu, Cheng-Qi Jia, Feng-Chih Kuo, Wei Chai, Ming-Hua Zhang, Ji-Ying Chen

Published in: BMC Musculoskeletal Disorders | Issue 1/2019

Login to get access

Abstract

Background

There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation.

Methods

A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed.

Results

There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli.

Conclusions

The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty.
(Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.)
Literature
1.
Jiranek WA, Waligora AC, Hess SR, Golladay GL. Surgical treatment of prosthetic joint infections of the hip and knee: changing paradigms? J Arthroplast. 2015;30:912–8.CrossRef
2.
Hsu Y-H, Hu C, Hsieh P-H, Shih H-N, Ueng SWN, Chang Y. Vancomycin and Ceftazidime in Bone Cement as a Potentially Effective Treatment for Knee Periprosthetic Joint Infection: The Journal of Bone and Joint Surgery 2017;99:223–31.CrossRef
3.
Ma D, Shanks RMQ, Davis CM, Craft DW, Wood TK, Hamlin BR, et al. Viable bacteria persist on antibiotic spacers following two-stage revision for periprosthetic joint infection. J Orthop Res. 2018;36:452–8.PubMed
4.
Bertazzoni Minelli E, Della Bora T, Benini A. Different microbial biofilm formation on polymethylmethacrylate (PMMA) bone cement loaded with gentamicin and vancomycin. Anaerobe. 2011;17:380–3.CrossRef
5.
Neut D, Hendriks JGE, van Horn JR, van der Mei HC, Busscher HJ. Pseudomonas aeruginosa biofilm formation and slime excretion on antibiotic-loaded bone cement. Acta Orthop. 2005;76:109–14.CrossRef
6.
Kelly EG, Cashman JP, Imran FH, Conroy R, O’Byrne J. Systematic review and meta-analysis of closed suction drainage versus non-drainage in primary hip arthroplasty. Surg Technol Int. 2014;24:295–301.PubMed
7.
Quinn M, Bowe A, Galvin R, Dawson P, O’Byrne J. The use of postoperative suction drainage in total knee arthroplasty: a systematic review. Int Orthop. 2015;39:653–8.CrossRef
8.
Abolghasemian M, Huether TW, Soever LJ, Drexler M, MacDonald MP, Backstein DJ. The use of a closed-suction drain in revision knee Arthroplasty may not be necessary. J Arthroplast. 2016;31:1544–8.CrossRef
9.
Fichman SG, Mäkinen TJ, Lozano B, Rahman WA, Safir O, Gross AE, et al. Closed suction drainage has no benefits in revision total hip arthroplasty: a randomized controlled trial. Int Orthop. 2016;40:453–7.CrossRef
10.
Abdel M, Barreira P, Battenberg A, Berry D, Blevins K, Font-Vizcarra L, et al. Hip and knee section. Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty: Treatment, Two-Stage Exchange Spacer-Related; 2018.
11.
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res. 2011;469:2992–4.CrossRef
12.
Ueng SWN, Hsieh P-H, Shih H-N, Chan Y-S, Lee MS, Chang Y. Antibacterial activity of joint fluid in cemented Total-knee Arthroplasty: an In Vivo comparative study of Polymethylmethacrylate with and without antibiotic loading. Antimicrob Agents Chemother. 2012;56:5541–6.CrossRef
13.
Hsieh P-H, Chang Y-H, Chen S-H, Ueng SWN, Shih C-H. High concentration and bioactivity of vancomycin and aztreonam eluted from simplex™ cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow-up of 107 days. J Orthop Res. 2006;24:1615–21.CrossRef
14.
Fink B, Vogt S, Reinsch M, Büchner H. Sufficient Release of Antibiotic by a Spacer 6 Weeks after Implantation in Two-stage Revision of Infected Hip Prostheses. Clinical Orthopaedics and Related Research®. 2011;(469):3141–7.CrossRef
15.
Kelm J, Regitz T, Schmitt E, Jung W, Anagnostakos K. In vivo and in vitro studies of antibiotic release from and bacterial growth inhibition by antibiotic-impregnated Polymethylmethacrylate hip spacers. Antimicrob Agents Chemother. 2006;50:332–5.CrossRef
16.
17.
Samuel S, Mathew BS, Veeraraghavan B, Fleming DH, Chittaranjan SB, Prakash JAJ. In vitro study of elution kinetics and bio-activity of meropenem-loaded acrylic bone cement. J Orthop Traumatol. 2012;13:131–6.CrossRef
18.
Baleani M, Persson C, Zolezzi C, Andollina A, Borrelli AM, Tigani D. Biological and biomechanical effects of Vancomycin and Meropenem in acrylic bone cement. J Arthroplast. 2008;23:1232–8.CrossRef
19.
Geller JA, Cunn G, Herschmiller T, Murtaugh T, Chen A. Acute kidney injury after first-stage joint revision for infection: risk factors and the impact of antibiotic dosing. J Arthroplast. 2017;32:3120–5.CrossRef
20.
Luu A, Syed F, Raman G, Bhalla A, Muldoon E, Hadley S, et al. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. 2013;(28):1490–1498.e1.
21.
Springer BD, Lee G-C, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ. Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res. 2004:47–51.CrossRef
22.
Hsieh P-H, Huang K-C, Tai C-L. Liquid gentamicin in bone cement spacers: in vivo antibiotic release and systemic safety in two-stage revision of infected hip Arthroplasty: the journal of trauma: injury. Infection, and Critical Care. 2009;66:804–8.CrossRef
Metadata
Title
Does the use of a closed-suction drain reduce the effectiveness of an antibiotic-loaded spacer in two-stage exchange Arthroplasty for Periprosthetic hip infection? A prospective, randomized, controlled study
Authors
Chi Xu
Cheng-Qi Jia
Feng-Chih Kuo
Wei Chai
Ming-Hua Zhang
Ji-Ying Chen
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2019
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-019-2974-5

Other articles of this Issue 1/2019

BMC Musculoskeletal Disorders 1/2019 Go to the issue

Correspondence

A consensus-based process identifying physical therapy and exercise treatments for patients with degenerative meniscal tears and knee OA: the TeMPO physical therapy interventions and home exercise program

Technical advance

Development of 3D method to assess intramuscular spatial distribution of fat infiltration in patients with rotator cuff tear: reliability and concurrent validity

Research article

The correlation analysis between sagittal alignment and cross-sectional area of paraspinal muscle in patients with lumbar spinal stenosis and degenerative spondylolisthesis

Research article

Hand injuries in an older population - a retrospective cohort study from a single hand surgery centre

Research article

Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis

Research article

Gait mechanics contribute to exercise induced pain flares in knee osteoarthritis