Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection
Background Periprosthetic infection develops in 0.5 to 5.0 % of cases after knee replacement, which is a social and economic problem. The most common causes of periprosthetic infection are methicillin-resistant staphylococcus aureus (MRSA) (36 %), gram-negative bacteria, and microbial associations...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
2023-04-01
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| Series: | Гений oртопедии |
| Subjects: |
| _version_ | 1797845018344423424 |
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| author | Stanislav A. Linnik Anna G. Afinogenova Gennady E. Afinogenov Anna A. Spiridonova Yaroslav B. Tsololo Giorgi Karagezov Valerii M. Khaidarov Dmitry V. Kravtsov Ivan O. Kucheev Aleksandr A. Khromov Ismael Abbas Maksim V. Maryshev |
| author_facet | Stanislav A. Linnik Anna G. Afinogenova Gennady E. Afinogenov Anna A. Spiridonova Yaroslav B. Tsololo Giorgi Karagezov Valerii M. Khaidarov Dmitry V. Kravtsov Ivan O. Kucheev Aleksandr A. Khromov Ismael Abbas Maksim V. Maryshev |
| author_sort | Stanislav A. Linnik |
| collection | DOAJ |
| description | Background Periprosthetic infection develops in 0.5 to 5.0 % of cases after knee replacement, which is a social and economic problem. The most
common causes of periprosthetic infection are methicillin-resistant staphylococcus aureus (MRSA) (36 %), gram-negative bacteria, and microbial
associations. The study was aimed at improving the results of the sanitizing stage of revision arthroplasty in patients with periprosthetic infection
of the knee joint by a developed long-acting antimicrobial composition and improving the designs of articulating spacers of the knee joint.
Materials and Methods The treatment results of 121 patients with knee joint periprosthetic infection were analyzed. Nine patients had an early
periprosthetic infection and 112 had a late one. Patients in satisfactory condition with stable implant components who had early periprosthetic
infection underwent surgical treatment of the purulent focuses, replacement of a polyethylene tibial insert, thorough surgical wound washing using
pulse lavage, drainage, and VAC-therapy. Patients with late periprosthetic infection were divided into 3 groups on the basis of the spacer used.
An articulating spacer based on the developed antimicrobial composition of prolonged action (RU 191236 patent) was used in 59 patients of the
first group. Preformed spacers were implanted in 29 patients of the second group, and 18 patients of the third group got a block-shaped spacer.
Results An antibacterial anti-adhesive non-toxic composition with a prolonged action based on bone cement with gentamicin and such antiseptics
as poviargol, dioxydine, and high-molecular polyvinylpyrrolidone has been developed. All the patients underwent the sanitizing stage of revision
arthroplasty, implant removal, and spacer installation. Periprosthetic infection recurrence developed in 3 patients of the first group, 9 patients of the second
group and 7 patients of the third one. The average time from the sanitizing stage to the second final stage of revision was 3-6 (4.8 ± 1.9) months.
Discussion According to scientific data, the impregnation of new antibiotics into bone cement with gentamicin does not improve the antimicrobial
effect of a spacer, especially in case of antibiotic-resistant strains. Block-shaped and preformed spacers lead to infection recurrence and complications.
Antiseptic impregnation with different mechanisms of action is able to affect antibiotic-resistant bacteria, and the polymer is able to prolong the effect.
Conclusion The use of articulating spacers for the knee joint, which include an antimicrobial composition, allows preserving the function of the joint
and reducing the number of infectious complications, which facilitates the final stage of revision arthroplasty. |
| first_indexed | 2024-04-09T17:31:47Z |
| format | Article |
| id | doaj.art-b332b950a0204d0cac202ae3be510b84 |
| institution | Directory Open Access Journal |
| issn | 1028-4427 2542-131X |
| language | English |
| last_indexed | 2024-04-09T17:31:47Z |
| publishDate | 2023-04-01 |
| publisher | Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics |
| record_format | Article |
| series | Гений oртопедии |
| spelling | doaj.art-b332b950a0204d0cac202ae3be510b842023-04-18T04:21:22ZengRussian Ilizarov Scientific Center for Restorative Traumatology and OrthopaedicsГений oртопедии1028-44272542-131X2023-04-0129217317910.18019/1028-4427-2023-29-2-173-179Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infectionStanislav A. Linnik0Anna G. Afinogenova1Gennady E. Afinogenov2Anna A. Spiridonova3Yaroslav B. Tsololo4Giorgi Karagezov5Valerii M. Khaidarov6Dmitry V. Kravtsov7Ivan O. Kucheev8Aleksandr A. Khromov9Ismael Abbas10 Maksim V. Maryshev11Mechnikov North-Western State Medical University, St. Petersburg, Russian FederationSaint Petersburg Pasteur Institute, St. Petersburg, Russian FederationSaint Petersburg University, St. Petersburg, Russian FederationSaint Petersburg Pasteur Institute, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationHospital for war veterans, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationMechnikov North-Western State Medical University, St. Petersburg, Russian FederationBackground Periprosthetic infection develops in 0.5 to 5.0 % of cases after knee replacement, which is a social and economic problem. The most common causes of periprosthetic infection are methicillin-resistant staphylococcus aureus (MRSA) (36 %), gram-negative bacteria, and microbial associations. The study was aimed at improving the results of the sanitizing stage of revision arthroplasty in patients with periprosthetic infection of the knee joint by a developed long-acting antimicrobial composition and improving the designs of articulating spacers of the knee joint. Materials and Methods The treatment results of 121 patients with knee joint periprosthetic infection were analyzed. Nine patients had an early periprosthetic infection and 112 had a late one. Patients in satisfactory condition with stable implant components who had early periprosthetic infection underwent surgical treatment of the purulent focuses, replacement of a polyethylene tibial insert, thorough surgical wound washing using pulse lavage, drainage, and VAC-therapy. Patients with late periprosthetic infection were divided into 3 groups on the basis of the spacer used. An articulating spacer based on the developed antimicrobial composition of prolonged action (RU 191236 patent) was used in 59 patients of the first group. Preformed spacers were implanted in 29 patients of the second group, and 18 patients of the third group got a block-shaped spacer. Results An antibacterial anti-adhesive non-toxic composition with a prolonged action based on bone cement with gentamicin and such antiseptics as poviargol, dioxydine, and high-molecular polyvinylpyrrolidone has been developed. All the patients underwent the sanitizing stage of revision arthroplasty, implant removal, and spacer installation. Periprosthetic infection recurrence developed in 3 patients of the first group, 9 patients of the second group and 7 patients of the third one. The average time from the sanitizing stage to the second final stage of revision was 3-6 (4.8 ± 1.9) months. Discussion According to scientific data, the impregnation of new antibiotics into bone cement with gentamicin does not improve the antimicrobial effect of a spacer, especially in case of antibiotic-resistant strains. Block-shaped and preformed spacers lead to infection recurrence and complications. Antiseptic impregnation with different mechanisms of action is able to affect antibiotic-resistant bacteria, and the polymer is able to prolong the effect. Conclusion The use of articulating spacers for the knee joint, which include an antimicrobial composition, allows preserving the function of the joint and reducing the number of infectious complications, which facilitates the final stage of revision arthroplasty.knee jointtwo-stage revision arthroplastyperiprosthetic infectionantimicrobial compositionspacer |
| spellingShingle | Stanislav A. Linnik Anna G. Afinogenova Gennady E. Afinogenov Anna A. Spiridonova Yaroslav B. Tsololo Giorgi Karagezov Valerii M. Khaidarov Dmitry V. Kravtsov Ivan O. Kucheev Aleksandr A. Khromov Ismael Abbas Maksim V. Maryshev Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection Гений oртопедии knee joint two-stage revision arthroplasty periprosthetic infection antimicrobial composition spacer |
| title | Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| title_full | Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| title_fullStr | Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| title_full_unstemmed | Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| title_short | Rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| title_sort | rationale for choosing a spacer at the first treatment stage for late deep periprosthetic knee joint infection |
| topic | knee joint two-stage revision arthroplasty periprosthetic infection antimicrobial composition spacer |
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