• Hip & pelvis
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• 제35권1호
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• pp.32-39
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• 2023

Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the "gold standard" for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer. Materials and Methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent two-stage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays. Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001). Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

• 대한족부족관절학회지
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• 제22권1호
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• pp.38-43
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• 2018

Purpose: Treatment of diabetic foot infection due to methicillin-resistant Staphylococcus aureus (MRSA) remains challenging. Applying vancomycin-impregnated cement is one of the best methods of treatment. Vancomycin-impregnated cement has been used worldwide; however, to date, there is a limited number of studies regarding its use. We evaluated the duration of antimicrobial activity of vancomycin-impregnated cement stored at room temperature after manufacturing. Materials and Methods: The vancomycin-impregnated cement was manufactured by mixing 1 g of vancomycin with 40 g of polymer and adding 17.90 g of liquid monomer. The cement dough was shaped into flat cylinders with diameter and height of 6 mm and 2 mm, respectively. Another cement of the same shape without mixing vancomycin was prepared as the negative control. All manufactured cements were sterilized with ethylene oxide gas and stored at room temperature. Each cement was placed on Mueller Hinton agar plate lawned with standard MRSA strain. Standard vancomycin disk and gentamicin disk were placed together. After 24 hours, the diameter of inhibition zone was measured, and if the diameter was less than 15 mm, vancomycin-impregnated cement was regarded as a loss of antimicrobial activity. The study was repeated every 2 weeks until vancomycin-impregnated cements lost their antimicrobial activity. Results: Vancomycin-impregnated cement stored for a duration of 16 weeks created a 14 mm inhibition zone, while vancomycin disk created a 15 mm inhibition zone. Vancomycin-impregnated cement stored for a duration of 17 weeks created 7 mm and 9 mm inhibition zones, while vancomycin disk created 16 mm and 15 mm inhibition zones, respectively. Conclusion: We found a decrease of antimicrobial activity in vancomycin-impregnated cements after 16 weeks. After 17 weeks, they showed definite loss of antimicrobial activity. Therefore, we recommend not using vancomycin-impregnated cement spacers that has been stored for more than 16 weeks at room temperature.

• 대한치과보철학회지
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• 제25권1호
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• pp.303-316
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• 1987

The purpose f this study was to evaluate the effect of resin film thickness on the tensile bond strength and to compare the tensile bond strengths of 4 differently treated metal surfaces. For the experiment, seventy metal specimens were cast with Verabond and divided into I, II, III, groups. The metal specimens in group I were electrolytically etched and cemented with Panavia under finger pressure. Cement film thickness was regulated with metal spacers. The metal specimens in Group II were treated by 4 methods, such as electrolytic etching method, salt-roughened method, EZ-oxisor method , chemical etching method and cemented with Panavia. In group III, electrolytically etched metal specimens were cemented with Hy-Bond. The etched surface of metal specimens and the cement film thickness were examined under the scanning electron microscope. Results were as follows; 1. The tensile bond strength showed no significant difference between $30{\mu}m,\;80{\mu}m,\;130{\mu}m$ film thicknessspecimens. 2. There was no significant difference in the tensile bond strength between the 4 differently treated metal specimens. 3. The tensile bond strength showed significant difference between Panavia and Hy-Bond. 4. Scanning electron microscope photograph revealed that tile interdendritic eutectic was removed in electrolytically etched metal surfaces hilt even dendritic arm was removed in Chemically etched metal surfaces. 5. The metal surfaces which were air-abraded with $50{\mu}m$ aluminum oxide showed roughness and small crack on scanning electron microscope photograph.

• 대한족부족관절학회지
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• 제23권2호
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• pp.58-66
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• 2019

Purpose: To evaluate the efficacy of antibiotic-loaded cement spacers (ALCSs) for the treatment of diabetic foot infections with osteomyelitis as a salvage procedure and to analyze the risk factors of treatment failure. Materials and Methods: This study reviewed retrospectively 39 cases of diabetic foot infections with osteomyelitis who underwent surgical treatment from 2009 to 2017. The mean age and follow-up period were $62{\pm}13years$ and $19.2{\pm}23.3months$, respectively. Wounds were graded using the Wagner and Strauss classification. X-ray, magnetic resonance imaging (or bone scan) and deep tissue cultures were taken preoperatively to diagnose osteomyelitis. The ankle-brachial index, toe-brachial index (TBI), and current perception threshold were checked. Lower extremity angiography was performed and if necessary, percutaneous transluminal angioplasty was conducted preoperatively. As a surgical treatment, meticulous debridement, bone curettage, and ALCS placement were employed in all cases. Between six and eight weeks after surgery, ALCS removal and autogenous iliac bone graft were performed. The treatment was considered successful if the wounds had healed completely within three months without signs of infection and no additional amputation within six months. Results: The treatment success rate was 82.1% (n=32); 12.8% (n=5) required additional amputation and 5.1% (n=2) showed delayed wound healing. Bacterial growth was confirmed in 82.1% (n=32) with methicillin-resistant Staphylococcus aureus being the most commonly identified strain (23.1%, n=9). The lesions were divided anatomically into four groups; the largest number was the toes: (1) toes (41.0%, n=16), (2) metatarsals (35.9%, n=14), (3) midfoot (5.1%, n=2), and (4) hindfoot (17.9%, n=7). A significant difference in the Strauss wound score and TBI was observed between the treatment success group and failure group. Conclusion: The insertion of ALCSs can be a useful treatment option in diabetic foot infections with osteomyelitis. Low scores in the Strauss classification and low TBI are risk factors of treatment failure.