gms | German Medical Science

Objectives: The main purpose of this study was to analyze the clinical features, the most common infective agents,and the clinical results of two-stage revision artroplasty using an teicoplanin-impregnated cement-spacer in a series of infected primary total hip replacements.

Methods: Between January 2005 and July 2012, 41 patients underwent two-stage revision arthroplasty with a diagnosis of deep persistent prosthetic joint infection were included in this retrospective study.

In the first stage, we applied teicoplanin-impregnated polymethylmethacrylate (PMMA) cement spacer which was fashioned intra-operatively and contained an average of 7.5 ± 2.6 grams (range, 4 to 16 grams) of teicoplanin for all hips after removal of all implants.In the second-stage, cement spacer block was removed and a new debridement was performed and cementless revision prosthetic components were then implanted following the preparation of the acetabular cavity and the femoral canal.

At the clinical status analysis,physical examination was performed, Harris hip score was noted,isolated microorganisms were recorded,and the radiographic evaluation was performed.

The Wilcoxon signed rank-sum test and Kaplan-Meier survival analysis was used for statistical analysis.

Results and Conclusion: Microbiologic cultures remained sterile with no isolated bacterial agent in 13 of 41 hips (31.7 %). Methicillin-resistant Staphylacoccus epidermidis (MRSE) was the most frequent pathogen which was isolated in 12 of 41 hips (29,3 %).

Infection was eradicated in 39 of 41 hips (95.1 %). The mean Harris hip score was improved from 39.2 points (range, 22.8 - 49 points) pre-operatively to 81.8 points (range,46.8 - 85 points) at the latest follow-up (p<0.05).

According to Kaplan-Meier survival analysis, the cumulative four-year survival rate in infected primary THA treated with two-stage revision surgery was 89.3% (95% confidence interval, 78% to 97%)

Surgical treatment of the patients with deep prosthetic joint infection following a primary hip replacement remains a challenge for orthopaedic surgeons. One or two-stage revision arthroplasty are the main treatment options. Although studies evaluating one-stage revision arthroplasty with comparable results have been published in the literature, many authors have recommended two-stage revision surgery as the first choice in the management of late onset prosthetic joint infection.

Except from the literature,we applied teicoplanin-impregnated cement spacer in our study. We did not observe any disadvantage or adverse effect of teicoplanin usage in intra-operatively fashioned antibiotic-impregnated cement spacer.

As a result we believed that teicoplanin is an effective antimicrobial agent and can be used in cement spacer in the treatment of infected hip arthroplasty. When we evaluated our results our treatment choice remains as two-staged procedure with its higher infection eradication rate especially for high-virulence microorganisms.