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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2010

01-10-2010 | Orthopaedic Surgery

Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks

Authors: Iori Takigami, Yoshiki Ito, Daichi Ishimaru, Hiroyasu Ogawa, Nobuyuki Mori, Takashi Shimizu, Nobuo Terabayashi, Katsuji Shimizu

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2010

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Abstract

Background

Infection of a hip prosthesis is one of the most severe complications encountered in orthopedic practice. Two-stage reconstruction using an antibiotic-impregnated cement spacer has become a popular procedure for the treatment of this condition. However, there are some disadvantages with the use of antibiotic-loaded cement, including low biocompatibility, a very low release ratio, and the possibility of thermal damage to the antibiotic. We have developed an effective drug delivery system for osteomyelitis in which porous hydroxyapatite (HA) blocks are loaded with an antibiotic by the vacuum method. We report here a modification of this delivery system applied for the first stage of two-stage reconstruction surgery against infected hip prosthesis.

Patients and methods

Eight consecutive patients who developed hip prosthesis infection underwent two-stage revision total hip arthroplasty (THA) using antibiotic-loaded porous HA blocks prepared by the vacuum method. Thorough debridement and insertion of antibiotic-loaded HA blocks was performed in the first stage, followed by conversion to THA after eradication of infection in the second stage.

Results

The mean interval between the stages was 16.8 weeks. There were no complications related to the use of the antibiotic-loaded HA blocks. The patients were followed up for an average of 49 months with no evidence of recurrent infection. The mean Japanese Orthopedic Association hip score improved from 45.1 before surgery to 79.6 at the latest follow-up.

Interpretation

This simple approach utilizing antibiotic-impregnated HA blocks prepared by the vacuum method is considered to be effective for treatment of hip prosthesis infection.
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Metadata
Title
Two-stage revision surgery for hip prosthesis infection using antibiotic-loaded porous hydroxyapatite blocks
Authors
Iori Takigami
Yoshiki Ito
Daichi Ishimaru
Hiroyasu Ogawa
Nobuyuki Mori
Takashi Shimizu
Nobuo Terabayashi
Katsuji Shimizu
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-009-0991-9

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