Antibiotic-loaded acrylic cement: current concepts.

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Infectious Disease

Background:

• Antibiotic-loaded acrylic cement has been a routine material in joint arthroplasty since 1972.
• Over 22,000 joint arthroplasty operations were performed between 1964-1983 using this material.
• Previous follow-up statistics on prophylactic therapy and deep infections have been published.

Purpose of the Study:

• To present the current status and updated follow-up statistics of antibiotic-loaded acrylic cement in joint arthroplasty.
• To compare the results of 869 exchange arthroplasties with previously published data.
• To introduce the use of survival curves for future analysis and comparison of treatment outcomes.

Main Methods:

• Retrospective actuarial analysis of 825 one-stage reimplantations for infected total hip arthroplasties.
• Utilized antibiotic-loaded acrylic cement in all cases.
• Statistical comparison of failure rates for different microorganisms, including Staphylococcus aureus, S. species, and Pseudomonas.

Main Results:

• Staphylococcus aureus was the most frequently identified organism in infected prostheses.
• Failure rates for prostheses infected by S. aureus, S. species, and anaerobic corynebacteria were not statistically different.
• Pseudomonas infection was identified as a significant factor contributing to treatment failure.

Conclusions:

• The study calculated a 77% success (survival) rate five years after operation for infected total hip arthroplasties treated with antibiotic-loaded acrylic cement.
• Survival curves are recommended for ease of comparison and analysis of covariable factors in future studies.
• While effective, Pseudomonas infections present a challenge to the success of this treatment method.