Antibiotics release from cement spacers used for two-stage treatment of implant-associated infections after total joint arthroplasty

Autor: Rainer Bader, Hans Bösebeck, Andreas Podbielski, Sylvio Redanz, Wolfram Mittelmeier, Tobias Reichel, Sarah Zaatreh, Annett Klinder, Martin Ellenrieder
Rok vydání: 2018
Předmět:
Male
antibiotics release
Time Factors
Knee Joint
medicine.medical_treatment
Arthroplasty
Replacement
Hip
cement spacer
Antibiotics
vancomycin
Periprosthetic
Prosthesis
0302 clinical medicine
revision arthroplasty
Prospective Studies
Arthroplasty
Replacement
Knee
Aged
80 and over
030222 orthopedics
0303 health sciences
Drug Carriers
periprosthetic joint infection
Bone Cements
Soft tissue
Middle Aged
Anti-Bacterial Agents
Vancomycin
Gentamicin
Drug Therapy
Combination
Female
Hip Joint
medicine.drug
medicine.medical_specialty
Materials science
Prosthesis-Related Infections
medicine.drug_class
Clinical Device‐Related Article
Biomedical Engineering
gentamicin
Biomaterials
03 medical and health sciences
In vivo
medicine
Humans
Polymethyl Methacrylate
Aged
two‐stage treatment
030306 microbiology
Surgery
Drug Liberation
Implant
Hip Prosthesis
Gentamicins
Zdroj: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
ISSN: 1552-4981
Popis: Two‐stage revision arthroplasty is the treatment of choice for periprosthetic infection, a serious complication after knee or hip arthroplasty. Our prospective clinical trial aimed to investigate the concentrations of gentamicin and vancomycin in wound exudate and tissue in two‐stage revision arthroplasty. Wound exudate and periprosthetic membrane samples were collected from 18 patients (10 hip and eight knee patients), who were due for two‐stage treatment after a periprosthetic joint infection. Samples were taken during insertion of antibiotic‐impregnated spacers and after their removal. The concentrations of gentamicin and vancomycin in wound exudates and adjacent tissue were analyzed using high‐performance liquid chromatography mass spectrometry. Average time period of spacer implantation was 13.6 weeks (9.3–22.6 weeks). The concentration of vancomycin in wound exudate decreased from a median of 43.28 μg/mL (0.28–261.22) after implantation to 0.46 μg/mL (0.13–37.47) after the removal of the spacer. In the adjacent tissue, vancomycin concentration was mainly undetectable prior to spacer implantation (0.003 μg/g [0.003–0.261]) and increased to 0.318 μg/g [0.024–484.16] at the time of spacer removal. This was also observed for gentamicin in the tissue of patients who previously had cement‐free implants (0.008 μg/g [0.008–0.087] vs. 0.164 μg/g [0.048–71.75]) while in the tissue of patients with previously cemented prosthesis, baseline concentration was already high (8.451 μg/g [0.152–42.926]). Despite the rapid decrease in antibiotics release from spacer cement observed in vitro, in vivo antibiotics are much longer detectable, especially in the adjacent soft tissue. © 2018 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published By Wiley Periodicals, Inc. J Biomed Mater Res B Part B, 2019. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1587–1597, 2019.
Databáze: OpenAIRE
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