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Deep infection in Charnley low-friction arthroplasty. Comparison of plain and gentamicin-loaded cement
Abstract:
A retrospective review of 1542 Charnley low-friction arthroplasties was carried out to compare the incidence of deep infection arising after plain and gentamicin-containing acrylic cement. There was no significant difference between the two series in primary operations, the infection rate being 1.72% and 1.65% respectively. However, in secondary operations (conversions and revisions) the gentamicin-containing cement gave significantly better results--a 0.81% infection rate as compared with 3.46%. All operations were performed in a clean air enclosure using total-body exhaust suits. Radiological diagnosis of deep infection was possible within one year of operation in all cases. Late haematogenous infection occurred in one case and was related to a skin lesion.
Insights
Gentamicin-containing bone cement did not significantly reduce deep infection rates in primary hip replacements. However, it substantially lowered infection rates in secondary hip revision surgeries.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Biomaterials Science
Background:
- Deep infection is a significant complication following hip arthroplasty.
- Acrylic bone cement is widely used in hip replacement procedures.
- The use of antibiotics within bone cement aims to reduce infection risk.
Purpose of the Study:
- To compare the incidence of deep infection after primary and secondary hip arthroplasties using plain versus gentamicin-containing acrylic cement.
- To evaluate the efficacy of gentamicin-loaded cement in preventing surgical site infections in hip replacement surgery.
Main Methods:
- Retrospective review of 1542 Charnley low-friction arthroplasties.
- Comparison of infection rates between plain and gentamicin-containing acrylic cement groups.
- Analysis of outcomes for both primary and secondary (conversion and revision) operations.
- All surgeries performed in a clean air enclosure with total-body exhaust suits.
Main Results:
- No significant difference in deep infection rates for primary operations (1.72% vs. 1.65%).
- Significantly lower infection rates in secondary operations with gentamicin-containing cement (0.81% vs. 3.46%).
- Radiological diagnosis of deep infection was possible within one year for all cases.
Conclusions:
- Gentamicin-containing acrylic cement offers significant benefits in reducing deep infection rates for secondary hip arthroplasty procedures (revisions and conversions).
- The routine use of gentamicin-loaded cement may be beneficial in revision hip surgery to mitigate infection risk.