Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions
Background: Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage rei...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Arthroplasty Today |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123002078 |
| _version_ | 1827349819844198400 |
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| author | Edward J. McPherson, MD Brooke M. Crawford, MD Steven G. Kenny, DO MPH Matthew V. Dipane, BS Shahrzad Salarkia, DNP Alexandra I. Stavrakis, MD Madhav Chowdhry, MBBS |
| author_facet | Edward J. McPherson, MD Brooke M. Crawford, MD Steven G. Kenny, DO MPH Matthew V. Dipane, BS Shahrzad Salarkia, DNP Alexandra I. Stavrakis, MD Madhav Chowdhry, MBBS |
| author_sort | Edward J. McPherson, MD |
| collection | DOAJ |
| description | Background: Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty. Methods: One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO4 was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years. Results: In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), P = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), P = .028. In both groups, there were no cases of aseptic stem loosening. Conclusions: Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence. |
| first_indexed | 2024-03-08T00:48:45Z |
| format | Article |
| id | doaj.art-2aa2261baab84c3b99757ca5f882f293 |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-08T00:48:45Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-2aa2261baab84c3b99757ca5f882f2932024-02-15T05:24:24ZengElsevierArthroplasty Today2352-34412024-02-0125101302Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic RevisionsEdward J. McPherson, MD0Brooke M. Crawford, MD1Steven G. Kenny, DO MPH2Matthew V. Dipane, BS3Shahrzad Salarkia, DNP4Alexandra I. Stavrakis, MD5Madhav Chowdhry, MBBS6Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Corresponding author. David Geffen School of Medicine at UCLA, Department of Orthopaedic Surgery, 1250 16th Street, Suite 2100, Santa Monica, CA 90404, USA. Tel.: +1 424 259 8598.Department of Orthopedic Surgery, The University of Miami Miller School of Medicine, Miami, FL, USADepartment of Orthopedic Surgery, The Permanente Medical Group, San Rafael, CA, USADepartment of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADepartment of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADepartment of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADepartment of Orthopedic Surgery, Jawaharlal Nehru Medical College, AMU, Aligarh, Uttar Pradesh, IndiaBackground: Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty. Methods: One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO4 was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years. Results: In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), P = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), P = .028. In both groups, there were no cases of aseptic stem loosening. Conclusions: Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence.http://www.sciencedirect.com/science/article/pii/S2352344123002078RevisionTotal hip arthroplastyCalcium sulfatePoint of careAntibiotic coating |
| spellingShingle | Edward J. McPherson, MD Brooke M. Crawford, MD Steven G. Kenny, DO MPH Matthew V. Dipane, BS Shahrzad Salarkia, DNP Alexandra I. Stavrakis, MD Madhav Chowdhry, MBBS Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions Arthroplasty Today Revision Total hip arthroplasty Calcium sulfate Point of care Antibiotic coating |
| title | Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions |
| title_full | Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions |
| title_fullStr | Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions |
| title_full_unstemmed | Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions |
| title_short | Point-of-Care Coating of Revision Femoral Stems With Antibiotic-Loaded Calcium Sulfate: Reduction in Infection After 2nd Stage Reimplantation but Not With Aseptic Revisions |
| title_sort | point of care coating of revision femoral stems with antibiotic loaded calcium sulfate reduction in infection after 2nd stage reimplantation but not with aseptic revisions |
| topic | Revision Total hip arthroplasty Calcium sulfate Point of care Antibiotic coating |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123002078 |
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