Single-Stage Revision of an Infected Total Hip Replacement Using Antibiotic-Impregnated Bioabsorbable Beads in a Canine Patient

Abstract

This report describes a technique and the outcome following surgical revision of a periprosthetic infected total hip replacement (THR) in a single-stage procedure with the use of antibiotic-impregnated bioabsorbable beads. A 6-year-old German Shepherd dog underwent THR 16 months previously, which subsequently became infected. The contaminated femoral and acetabular prostheses were explanted. A femoral window was used to remove the stem and cement. The endosteal surfaces of the femur and acetabulum were reamed to remove periprosthetic tissues. The femoral window was replaced and secured in position with multiple cerclage wires. A 3.5-mm locking plate was applied to the lateral aspect of the femur to prevent fracture of the proximal femoral metaphysis and trochanter. Bioabsorbable beads of calcium sulphate, impregnated with vancomycin and gentamicin, were impacted into the femoral canal followed by an uncemented femoral stem. An uncemented acetabular implant was impacted and additional antibiotic beads placed in the vicinity prior to closure. There has been no evidence of reinfection 5 years postoperatively. Analgesic and antibacterial drugs were not required during this follow-up period; activity is unrestricted with neither lameness nor pain present. Simultaneous revision of both femoral and acetabular periprosthetic infected THR implants was successfully achieved in this patient via a single-stage procedure using uncemented implants and antibiotic-impregnated bioabsorbable beads.

Keywords

infection - total hip replacement - bioabsorbable beads

Author Contribution

Both authors contributed to conception of study, study design, acquisition of data and data analysis and interpretation. Both of them also drafted, revised and approved the submitted manuscript.

• References

• 1 Dyce J, Wisner ER, Wang Q, Olmstead ML. Evaluation of risk factors for luxation after total hip replacement in dogs. Vet Surg 2000; 29 (06) 524-532
• 2 Bergh MS, Gilley RS, Shofer FS, Kapatkin AS. Complications and radiographic findings following cemented total hip replacement: a retrospective evaluation of 97 dogs. Vet Comp Orthop Traumatol 2006; 19 (03) 172-179
• 3 Olmstead ML, Hohn RB, Turner TM. A five-year study of 221 total hip replacements in the dog. J Am Vet Med Assoc 1983; 183 (02) 191-194
• 4 Girling SL, Innes JF. Infection of a total hip prosthesis in a dog caused by Achromobacter(Alcaligenes) xylosoxidans. J Small Anim Pract 2006; 47 (12) 747-750
• 5 Massat BJ, Miller RT, DeYoung BA, Schiller RA, Aberman HM, DeYoung DJ. Single-stage revision using an uncemented, porous-coated, anatomic endoprosthesis in two dogs: case report. Vet Surg 1998; 27 (03) 268-277
• 6 Torres BT, Budsberg SC. Revision of cemented total hip arthroplasty with cementless components in three dogs. Vet Surg 2009; 38 (01) 81-86
• 7 Ficklin MG, Kowaleski MP, Kunkel KA, Suber JT. One-stage revision of an infected cementless total hip replacement. Vet Comp Orthop Traumatol 2016; 29 (06) 541-546
• 8 Raut VV, Siney PD, Wroblewski BM. One-stage revision of infected total hip replacements with discharging sinuses. J Bone Joint Surg Br 1994; 76 (05) 721-724
• 9 Ure KJ, Amstutz HC, Nasser S, Schmalzried TP. Direct-exchange arthroplasty for the treatment of infection after total hip replacement. An average ten-year follow-up. J Bone Joint Surg Am 1998; 80 (07) 961-968
• 10 Klouche S, Sariali E, Mamoudy P. Total hip arthroplasty revision due to infection: a cost analysis approach. Orthop Traumatol Surg Res 2010; 96 (02) 124-132
• 11 Lange J, Troelsen A, Thomsen RW, Søballe K. Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis. Clin Epidemiol 2012; 4: 57-73
• 12 Leonard HA, Liddle AD, Burke O, Murray DW, Pandit H. Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 2014; 472 (03) 1036-1042
• 13 Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. ; INFORM Team. Re-infection outcomes following one- and two-stage surgical revision of infected hip prosthesis: a systematic review and meta-analysis. PLoS One 2015; 10 (09) e0139166
• 14 Zeller V, Lhotellier L, Marmor S. , et al. One-stage exchange arthroplasty for chronic periprosthetic hip infection: results of a large prospective cohort study. J Bone Joint Surg Am 2014; 96 (01) e1
• 15 Ham K, Griffon D, Seddighi M, Johnson AL. Clinical application of tobramycin-impregnated calcium sulfate beads in six dogs (2002-2004). J Am Anim Hosp Assoc 2008; 44 (06) 320-326
• 16 Piermattei DL, Johnson KA. An Atlas of Surgical Approaches to Bones and Joints of the Dog and Cat. St. Louis: Elsevier Saunders; 2004
• 17 Dyce J, Olmstead ML. Removal of infected canine cemented total hip prostheses using a femoral window technique. Vet Surg 2002; 31 (06) 552-560
• 18 Voss K, Imhof J, Kaestner S, Montavon PM. Force plate gait analysis at the walk and trot in dogs with low-grade hindlimb lameness. Vet Comp Orthop Traumatol 2007; 20 (04) 299-304
• 19 Spangehl MJ, Younger AS, Masri BA. , et al. Diagnosis of infection following total hip arthroplasty. J Bone Joint Surg Am 1997; 79: 1578-1588
• 20 Winkler H. Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft. Int J Med Sci 2009; 6 (05) 247-252
• 21 Fux CA, Stoodley P, Hall-Stoodley L, Costerton JW. Bacterial biofilms: a diagnostic and therapeutic challenge. Expert Rev Anti Infect Ther 2003; 1 (04) 667-683
• 22 Mariaux S, Tafin UF, Borens O. Diagnosis of persistent infection in prosthetic two-stage exchange: PCR analysis of sonication fluid from bone cement spacers. J Bone Jt Infect 2017; 2 (04) 218-223
• 23 Bertazzoni Minelli E, Della Bora T, Benini A. Different microbial biofilm formation on polymethylmethacrylate (PMMA) bone cement loaded with gentamicin and vancomycin. Anaerobe 2011; 17 (06) 380-383
• 24 Senthi S, Munro JT, Pitto RP. Infection in total hip replacement: meta-analysis. Int Orthop 2011; 35 (02) 253-260
• 25 Stimulan Rapid Cure. Available at: http://www.biocomposites.com/our-products/stimulan/ . Accessed March 2, 2018
• 26 Diribe O, Thomas S, AbuOun M, Fitzpatrick N, La Ragione R. Genotypic relatedness and characterization of Staphylococcus pseudintermedius associated with post-operative surgical infections in dogs. J Med Microbiol 2015; 64: 1074-1081
• 27 Rothman RH, Cohn JC. Cemented versus cementless total hip arthroplasty. A critical review. Clin Orthop Relat Res 1990; (254) 153-169
• 28 Park DK, Della Valle CJ, Quigley L, Moric M, Rosenberg AG, Galante JO. Revision of the acetabular component without cement. A concise follow-up, at twenty to twenty-four years, of a previous report. J Bone Joint Surg Am 2009; 91 (02) 350-355
• 29 Gristina AG, Naylor P, Myrvik Q. Infections from biomaterials and implants: a race for the surface. Med Prog Technol 1988; -1989: 14 (3-4): 205-224
• 30 Diefenbeck M, Mückley T, Hofmann GO. Prophylaxis and treatment of implant-related infections by local application of antibiotics. Injury 2006; 37 (Suppl. 02) S95-S104
• 31 Hayes G, Moens N, Gibson T. A review of local antibiotic implants and applications to veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2013; 26 (04) 251-259
• 32 Agarwal S, Healey B. The use of antibiotic impregnated absorbable calcium sulphate beads in management of infected joint replacement prostheses. J Arthrosc Jt Surg 2014; 2: 72-75
• 33 McPherson EJ, Dipane MV, Sherif SM. Dissolvable antibiotic beads in treatment of periprosthetic joint infection and revision arthroplasty. The use of synthetic pure calcium sulfate (Stimulan) impregnated with vancomycin & tobramycin. Reconstr Rev 2013; 3: 32-43
• 34 Kanellakopoulou K, Panagopoulos P, Giannitsioti E. , et al. In vitro elution of daptomycin by a synthetic crystallic semihydrate form of calcium sulfate, Stimulan. Antimicrob Agents Chemother 2009; 53 (07) 3106-3107
• 35 Gauland C. Managing lower-extremity osteomyelitis locally with surgical debridement and synthetic calcium sulfate antibiotic tablets. Adv Skin Wound Care 2011; 24 (11) 515-523
• 36 Owen MR, Moores AP, Coe RJ. Management of MRSA septic arthritis in a dog using a gentamicin-impregnated collagen sponge. J Small Anim Pract 2004; 45 (12) 609-612
• 37 Renwick AI, Dennis R, Gemmill TJ. Treatment of lumbosacral discospondylitis by surgical stabilisation and application of a gentamicin-impregnated collagen sponge. Vet Comp Orthop Traumatol 2010; 23 (04) 266-272