In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid ...In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance.In the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen.Instead of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre.The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.展开更多
Prosthetic joint infection(PJI)is the most serious complication following total joint arthroplasty,this being because it is associated with,among other things,high morbidity and low quality of life,is difficult to pre...Prosthetic joint infection(PJI)is the most serious complication following total joint arthroplasty,this being because it is associated with,among other things,high morbidity and low quality of life,is difficult to prevent,and is very challenging to treat/manage.The many shortcomings of antibiotic-loaded poly(methyl methacrylate)(PMMA)bone cement(ALBC)as an agent for preventing and treating/managing PJI are well-known.One is that microorganisms responsible for most PJI cases,such as methicillin-resistant S.aureus,have developed or are developing resistance to gentamicin sulfate,which is the antibiotic in the vast majority of approved ALBC brands.This has led to many research efforts to develop cements that do not contain gentamicin(or,for that matter,any antibiotic)but demonstrate excellent antimicrobial efficacy.There is a sizeable body of literature on these socalled“antibiotic-free antimicrobial”PMMA bone cements(AFAMBCs).The present work is a comprehensive and critical review of this body.In addition to summaries of key trends in results of characterization studies of AFAMBCs,the attractive features and shortcomings of the literature are highlighted.Shortcomings provide motivation for future work,with some ideas being formulation of a new generation of AFAMBCs by,example,adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement,respectively.展开更多
Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.W...Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.We aimed to compare the occurrence rate of PJI using two different cements,and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection(SSI)with ALBC.Methods:The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching"total knee arthroplasty","antibiotic-loaded cement","antibiotic prophylaxis","antibiotic-impregnated cement"and"antibiotic-laden cement"in the database of PubMed/MEDLINE,Embase,Web of Science and the Cochrane Library.Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC.The modified Jadad scale was employed to score the qualities of included articles.Results:Eleven quantitative studies were enrolled,including 34,159 knees undergoing PTKA.The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA,whereas there was no significant reduction in the rate of superficial incisional SSI.Moreover,gentamicin-loaded cement was effective in preventing deep incisional SSI,and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA.Besides,no significant adverse reactions and complications were stated during the use of ALBC in PTKA.Conclusion:The preventive application of ALBC during PTKA could reduce the rates of deep PJI.Furthermore,bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA.However,the existing related articles are mostly single展开更多
AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retro...AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.展开更多
文摘In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance.In the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen.Instead of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre.The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.
文摘Prosthetic joint infection(PJI)is the most serious complication following total joint arthroplasty,this being because it is associated with,among other things,high morbidity and low quality of life,is difficult to prevent,and is very challenging to treat/manage.The many shortcomings of antibiotic-loaded poly(methyl methacrylate)(PMMA)bone cement(ALBC)as an agent for preventing and treating/managing PJI are well-known.One is that microorganisms responsible for most PJI cases,such as methicillin-resistant S.aureus,have developed or are developing resistance to gentamicin sulfate,which is the antibiotic in the vast majority of approved ALBC brands.This has led to many research efforts to develop cements that do not contain gentamicin(or,for that matter,any antibiotic)but demonstrate excellent antimicrobial efficacy.There is a sizeable body of literature on these socalled“antibiotic-free antimicrobial”PMMA bone cements(AFAMBCs).The present work is a comprehensive and critical review of this body.In addition to summaries of key trends in results of characterization studies of AFAMBCs,the attractive features and shortcomings of the literature are highlighted.Shortcomings provide motivation for future work,with some ideas being formulation of a new generation of AFAMBCs by,example,adding a nanostructured material and/or an extract from a natural product to the powder and/or liquid of the basis cement,respectively.
基金This research received no specific grant from any funding agency in the public,commercial,or not-for-profit sectors.
文摘Purpose:Antibiotic-loaded bone cement(ALBC)was usually used to prevent periprosthetic joint infection(PJI)in primary total knee arthroplasty(PTKA),but whether to use ALBC or plain bone cement in PTKA remains unclear.We aimed to compare the occurrence rate of PJI using two different cements,and to investigate the efficacy of different antibiotic types and doses administered in preventing surgical site infection(SSI)with ALBC.Methods:The availability of ALBC for preventing PJI was evaluated by using a systematic review and meta-analysis referring to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Existing articles until December 2021 involving PTKA patients with both ALBC and plain bone cement cohorts were scanned by searching"total knee arthroplasty","antibiotic-loaded cement","antibiotic prophylaxis","antibiotic-impregnated cement"and"antibiotic-laden cement"in the database of PubMed/MEDLINE,Embase,Web of Science and the Cochrane Library.Subgroup analysis included the effectiveness of different antibiotic types and doses in preventing SSI with ALBC.The modified Jadad scale was employed to score the qualities of included articles.Results:Eleven quantitative studies were enrolled,including 34,159 knees undergoing PTKA.The meta-analysis results demonstrated that the use of prophylactic ALBC could significantly reduce the prevalence of deep incisional SSI after PTKA,whereas there was no significant reduction in the rate of superficial incisional SSI.Moreover,gentamicin-loaded cement was effective in preventing deep incisional SSI,and the use of high-dose ALBC significantly reduced the rate of deep incisional SSI after PTKA.Besides,no significant adverse reactions and complications were stated during the use of ALBC in PTKA.Conclusion:The preventive application of ALBC during PTKA could reduce the rates of deep PJI.Furthermore,bone cement containing gentamicin and high-dose ALBC could even better prevent deep infection after PTKA.However,the existing related articles are mostly single
文摘AIM: To investigate the effectiveness of two-stage reimplantation using antibiotic-loaded bone cement(ALBC) and the risk factors associated with failure to control periprosthetic joint infection(PJI).METHODS: We retrospectively reviewed 38 consecutive hips managed using two-stage reimplantation with ALBC. The mean follow-up period was 5.4 years(range: 2.5-9 years). RESULTS: The causative pathogens were isolated from 29 patients(76%), 26 of whom were infected with highly virulent organisms. Sixteen patients(42%) underwent at least two first-stage debridements. An increased debridement frequency correlated significantly with high comorbidity(P < 0.001), a lower preoperative Harris hip score(HHS; P < 0.001), antimicrobial resistance, and gram-negative and polymicrobial infection(P = 0.002). Of the 35 patients who underwent two-stage reimplantation, 34 showed no signs of recurrence of infection. The mean HHS improved from 46 ± 12.64 to 78 ± 10.55 points, with 7(20%), 12(34%), 11(32%)and 5(14%) patients receiving excellent, good, fair and poor ratings, respectively. CONCLUSION: The current study demonstrated that two-stage reimplantation could successfully treat PJI after hip arthroplasty. However, the ability of ALBC to eradicate infection was limited because frequent debridement was required in high-risk patients(i.e., patients who are either in poor general health due to associated comorbidities or harbor infections due to highly virulent, difficult-to-treat organisms). Level of evidence: Level Ⅳ.
