Related Experiment Videos
Minimum 5 years' follow-up after gentamicin- and clindamycin-loaded PMMA cement in total joint arthroplasty
Hussein Abdelaziz1, Götz von Förster1, Klaus-Dieter Kühn2
11Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany.
Purpose:
Due to numerous advantages of the combination of clindamycin and gentamicin in polymethylmethacrylate (PMMA) cement, promising preliminary results have been reported. However, there are no data that analyse mid-term outcomes.
Methodology:
This pilot study included patients who experienced 5 years of follow-up and who were treated with gentamicin- and clindamycin-loaded (G+C) PMMA cement. They were divided into two groups: (1) the periprosthetic joint infection (PJI) comprising patients who underwent a one-stage exchange, and (2) aseptic group comprising patients who underwent aseptic revision or primary arthroplasty procedures, but were considered to be high-risk patients for infection. We evaluated the rate of septic and aseptic revision arthroplasty with a minimum of 5-year follow-up.Results/Key findings. A total of 32 patients in both groups were included. Eighteen patients belonged to the PJI-group and 14 belonged to the aseptic group. There was no reinfection among the patients of the PJI group. Infection was prevented in the aseptic group, including patients with a history of PJI or at higher risk of infection. No patient underwent an exchange of the cemented prosthesis at the 5-year follow-up [72-82 months, standard deviation (sd)=3.3].
Conclusions:
The local use of G+C bone cement during septic and aseptic revision arthroplasty, was associated with a high success rate for the eradication of infection following one-stage septic exchange, and with prevention of infection in high-risk patients.
Insights
Local use of gentamicin and clindamycin bone cement (G+C) in polymethylmethacrylate (PMMA) showed high success in treating periprosthetic joint infection (PJI) and preventing infection in high-risk patients during revision arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Management
- Biomaterials Science
Background:
- Polymethylmethacrylate (PMMA) bone cement loaded with gentamicin and clindamycin (G+C) shows promise for treating bone infections.
- Limited mid-term outcome data exist for G+C PMMA cement in revision arthroplasty.
Purpose of the Study:
- To evaluate the mid-term outcomes of G+C PMMA cement in revision arthroplasty.
- To assess the efficacy of G+C PMMA cement in eradicating infection and preventing new infections.
Main Methods:
- Pilot study with 5-year follow-up.
- Patients treated with G+C PMMA cement were divided into two groups: periprosthetic joint infection (PJI) undergoing one-stage exchange and high-risk aseptic revision/primary arthroplasty patients.
- Evaluated septic and aseptic revision rates.
Main Results:
- No reinfection occurred in the 18 PJI patients.
- Infection was prevented in the 14 high-risk aseptic patients.
- No cemented prosthesis exchanges were required at 5-year follow-up (72-82 months).
Conclusions:
- Local G+C PMMA cement is highly effective for eradicating infection in one-stage septic exchange arthroplasty.
- G+C PMMA cement successfully prevents infection in high-risk aseptic patients undergoing revision or primary arthroplasty.