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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Management of infected bulk allografts with antibiotic-impregnated polymethylmethacrylate spacers
R H Quinn1, H J Mankin, D S Springfield
1Department of Orthopedic Surgery, University of Connecticut School of Medicine/Hartford Hospital, USA.
Abstract:
Twenty-seven patients developed infection following bulk allograft transplantation and were treated with resection of the allograft, placement of an antibiotic-impregnated polymethylmethacrylate (PMMA) spacer, and intravenous antibiotics. Overall, the infection was eradicated in 14 (52%) of 27 patients. Of the 11 patients who did not undergo allograft reimplantation, 5 underwent amputations for persistent infection in the presence of the spacer and 4 had a retained spacer at most recent follow-up. No significant correlation was noted between successful eradication of the infection and age, sex, diagnosis, adjuvant therapy, acute or chronic infection, number of operative procedures, type of allograft procedure, duration of antibiotics, or type of organism. Although deep infection of allograft transplantations continues to result in a high rate of failure, this method of management results in successful limb salvage in almost half of the patients.
Insights
Infection after allograft transplantation is challenging. This study shows that antibiotic-impregnated polymethylmethacrylate (PMMA) spacers can successfully salvage limbs in 52% of patients, though infection eradication remains difficult.
Area of Science:
- Orthopedics
- Infectious Disease
- Biomaterials
Background:
- Deep infection following allograft transplantation presents a significant clinical challenge.
- Effective management strategies are crucial for limb salvage and infection control.
Purpose of the Study:
- To evaluate the efficacy of a management protocol involving allograft resection, antibiotic-impregnated polymethylmethacrylate (PMMA) spacer placement, and intravenous antibiotics for deep infections after allograft transplantation.
- To determine the rate of infection eradication and limb salvage in patients treated with this protocol.
Main Methods:
- A retrospective review of 27 patients who developed deep infection post-allograft transplantation.
- Treatment included allograft resection, placement of an antibiotic-impregnated PMMA spacer, and intravenous antibiotics.
- Outcomes assessed included infection eradication and limb salvage rates.
Main Results:
- Overall infection eradication was achieved in 14 (52%) of 27 patients.
- Among 11 patients not undergoing reimplantation, 5 required amputation due to persistent infection, and 4 retained the spacer at follow-up.
- No significant correlation was found between successful eradication and patient demographics, infection characteristics, or treatment variables.
Conclusions:
- The management of deep allograft infections using PMMA spacers offers a limb salvage rate of approximately 52%.
- Despite this, deep infection following allograft transplantation continues to have a high failure rate.
- Further research is needed to improve outcomes for these complex infections.
