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Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty–should we use antibiotic-loaded bone cement?

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World Journal of Orthopedics 2022年第2期13卷 150-159页

作者： Diana Crego-Vita Daniel Aedo-Martín Rafael Garcia-Cañas Andrea Espigares-Correa Coral Sánchez-Pérez Christof Ernst Berberich Department of Orthopaedic and Trauma Surgery Hospital Central de la Defensa Gómez UllaMadrid 28047Spain Department of Orthopaedic and Trauma Surgery Hospital Universitario del HenaresUniversidad Francisco de VitoriaCoslada 28822MadridSpain Department of Orthopeadic and Trauma Surgery Hospital Central de la Defensa Gómez UllaMadrid 28047Spain Department of Orthopeadic and Trauma Surgery General University Hospital Gregorio MaranonMadrid 28007Spain Department of Medical Training Heraeus Medical GmbHWehrheim 612173HessenGermany

BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture(FNF).Prosthetic joint infection(PJI)is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track ***,priorities should lie in effective preventive strategies to mitigate this *** To determine how much the implementation of the routine use of antibioticloaded bone cement(ALBC)as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty *** We retrospectively assessed all demographic,health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017;241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation *** PJI rate as diagnosed on basis of the Musculoskeletal Infection Society(MSIS)criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem *** were split into a group receiving a plain bone cement in the period from January 2011 to June 2013(non-ALBC group)and into a group receiving an ALBC in the period July 2013 to December 2017(ALBC group).Data analysis was performed with statistical *** further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the inhospital infection related treatment costs with the extra costs of use of *** In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective *** were 8 PJI cases identified in the ALBC group among n=94 patients,whereas 28 PJI cases were observed in the non-ALBC group among n=147 *** statistical analysis

关键词： prosthetic joint infection Femoral neck fracture patients Hemiarthroplasty antibiotic-loaded bone cement Prophylaxis Cost-efficacy

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Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

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World Journal of Orthopedics 2021年第3期12卷 119-128页

作者： Christof Ernst Berberich Jérome Josse Frédéric Laurent Tristan Ferry Department of Medical Training Heraeus Medical GmbHWehrheim 612173HessenGermany Institut des Sciences Pharmaceutiques et Biologiques de Lyon(ISPB) International Center for Research in InfectiologyInserm U1111CNRS UMR5308ENS de LyonUCBL1Lyon 69008France Interregional Reference Center for the Management of Complex Osteo-Articular Infections Hospices Civils de LyonLyon 69008France Bacteriology Laboratory Institute of Infectious AgentsCroix-Rousse HospitalHospices Civils de LyonLyon 69008France Infectious and Tropical Diseases Department Croix-Rousse HospitalHospices Civils de LyonLyon 69008France

In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally ***,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest *** the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis *** of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the *** more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.

关键词： Prosthetic joint infection antibiotic-loaded bone cement Single low dose antibiotic-loaded bone cement Dual high dose antibiotic-loaded bone cement antibiotic prophylaxis Risk-for-infection patients

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