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Vet Comp Orthop Traumatol 2016; 29(06): 541-546
DOI: 10.3415/VCOT-16-01-0004
Case Report
Schattauer GmbH

One-stage revision of an infected cementless total hip replacement

Michael G. Ficklin
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
,
Michael P. Kowaleski
2   Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
,
Kevin A. R. Kunkel
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
,
Jonathan T. Suber
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
› Author Affiliations
Further Information

Publication History

Received: 11 January 2016

Accepted: 26 July 2016

Publication Date:
19 December 2017 (online)

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Summary

A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.

Keywords

Silver - single stage revision - resistant infection - total hip replacement - canine - dog
 

  • References

  • 1 Conzemius MG, Vandervoort J. Total joint replacement in the dog. Vet Clin North Am Small Anim Pract 2005; 35: 1213-1231.
    CrossrefPubMedGoogle Scholar
  • 2 Andreoni AA, Guerrero TG, Hurter K. et al. Revision of an unstable HELICA endoprosthesis with a Zurich cementless total hip replacement. Vet Comp Orthop Traumatol 2010; 23: 177-181.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Guerrero TG, Montavon PM. Zurich cementless total hip replacement: retrospective evaluation of 2nd generation implants in 60 dogs. Vet Surg 2009; 38: 70-80.
    CrossrefPubMedGoogle Scholar
  • 4 Gemmill TJ, Pink J, Renwick A. et al. Hybrid cemented/cementless total hip replacement in dogs: seventy-eight consecutive joint replacements. Vet Surg 2011; 40: 621-630.
    CrossrefPubMedGoogle Scholar
  • 5 Schulz KS. Application of arthroplasty principles to canine cemented total hip replacement. Vet Surg 2000; 29: 578-593.
    CrossrefPubMedGoogle Scholar
  • 6 Cross AR, Newell SM, Chambers JN. et al. Acetabular component orientation as an indicator of implant luxation in cemented total hip arthroplasty. Vet Surg 2000; 29: 517-523.
    CrossrefPubMedGoogle Scholar
  • 7 Bergh MS, Gilley RS, Shofer FS. et al. Complications and radiographic findings following cemented total hip replacement: a retrospective evaluation of 97 dogs. Vet Comp Orthop Traumatol 2006; 19: 172-179.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Torres BT, Budsberg SC. Revision of cemented total hip arthroplasty with cementless components in three dogs. Vet Surg 2009; 38: 81-86.
    CrossrefPubMedGoogle Scholar
  • 9 Bozic KJ, Kurtz SM, Lau E. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91: 128-133.
    CrossrefPubMedGoogle Scholar
  • 10 Iwata D, Broun HC, Black AP. et al. Total hip arthroplasty outcomes assessment using functional and radiographic scores to compare canine systems. Vet Comp Orthop Traumatol 2008; 21: 221-230.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Romano CL, Romano D, Logoluso N. et al. Septic versus aseptic total hip revision: how different?. J Orthop Traumatol 2010; 11: 167-174.
    CrossrefPubMedGoogle Scholar
  • 12 Vielpeau C, Lortat-Jacob A, Coll A. Management of the infected hip prostheses. Rev Chir Orthop 2002; 88 (Suppl. 01) 159-216.
    PubMedGoogle Scholar
  • 13 Muñoz-Mahamud E, Gallart X, Soriano A. One-stage revision arthroplasty for infected hip replacements. Open Orthop J 2013; 7: 184-189.
    CrossrefPubMedGoogle Scholar
  • 14 Massat BJ, Miller RT, DeYoung BA. et al. Single-stage revision using an uncemented, porous-coated, anatomic endoprosthesis in two dogs: case report. Vet Surg 1998; 27: 268-277.
    CrossrefPubMedGoogle Scholar
  • 15 Slocum B, Slocum TD. Tibial plateau levelling osteotomy for repair of cranial cruciate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993; 23: 777-795.
    CrossrefPubMedGoogle Scholar
  • 16 Dyce J, Olmstead ML. Removal of infected canine cemented total hip prostheses using a femoral window technique. Vet Surg 2002; 31: 552-560.
    CrossrefPubMedGoogle Scholar
  • 17 Ireifej S, Marino DJ, Loughin CA. et al. Risk factors and clinical relevance of positive intraoperative bacterial cultures in dogs with total hip replacement. Vet Surg 2012; 41: 63-68.
    CrossrefPubMedGoogle Scholar
  • 18 Hudetz D, Rod E, Radic A. et al. Diagnosis and treatment of peri-prosthetic infections in total hip replacement. Med Glas (Zenica) 2012; 9: 152-159.
    PubMedGoogle Scholar
  • 19 Sharf VF, Lewis ST, Wellehan JF. et al. Retrospective evaluation of the efficacy of isolating bacteria from synovial fluid in dogs with suspected septic arthritis. Aust Vet J 2015; 93: 200-203.
    CrossrefPubMedGoogle Scholar
  • 20 Biau DJ, Leclerc P, Marmor S. et al. Monitoring the one year postoperative infection rate after primary total hip replacement. Int Orthop 2012; 36: 1155-1161.
    CrossrefPubMedGoogle Scholar
  • 21 Hummel DW, Lanz OL, Werre SR. Complications of cementless total hip replacement. A retrospective study of 163 cases. Vet Comp Orthop Traumatol 2010; 23: 424-432.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Lidwell OM, Lowbury EJ, Whyte W. et al. Infection and sepsis after operations for total hip or knee-joint replacement: influence of ultraclean air, prophylactic antibiotics and other factors. J Hyg (Lond) 1984; 93: 505-529.
    CrossrefPubMedGoogle Scholar
  • 23 Haddad FS, Muirhead-Allwood SK, Manktelow AR. et al. Two-stage uncemented revision hip arthroplasty for infection. J Bone Joint Surg Br 2000; 82: 689-694.
    CrossrefPubMedGoogle Scholar
  • 24 Fink B, Grossmann A, Fuerst M. et al. Two-stage cementless revision of infected hip endoprostheses. Clin Orthop Relat Res 2009; 467: 1448-1458.
    PubMedGoogle Scholar
  • 25 Ellenrieder M, Lenz R, Haenle M. et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip 2011; 6: D-oc17.
    PubMedGoogle Scholar
  • 26 Ilchmann T, Zimmerli W, Ochsner PE. et al. One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips. Int Orthop 2016; 40: 913-918.
    CrossrefPubMedGoogle Scholar
  • 27 Osmon DR, Berbari EF, Berendt AR. et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2013; 56: 1-10.
    CrossrefPubMedGoogle Scholar
  • 28 Batzias GC, Delis GA, Athanasiou LV. Clindamycin bioavailability and pharmacokinetics following oral administration of clindamycin hydrochloride capsules in dogs. Vet J 2005; 170: 339-345.
    CrossrefPubMedGoogle Scholar
  • 29 Dan BJ, Kim SE, Pozzi A. Management of an infected cementless cup with prosthetic retention and antibiotic therapy in a dog. J Small Anim Pract 2014; 55: 585-588.
    CrossrefPubMedGoogle Scholar
  • 30 Turner TM, Urban RM, Sumner DR. et al. Revision, without cement, of aseptically loose, cemented total hip prostheses. Quantitative comparison of the effects of four types of medullary treatment on bone ingrowth in a canine model. J Bone Joint Surg Am 1993; 75: 845-862.
    CrossrefPubMedGoogle Scholar
  • 31 Shukla A, Fang JC, Puranam S. et al. Release of vancomycin from multilayer coated absorbent gelatin sponges. J Control Release 2012; 157: 64-67.
    CrossrefPubMedGoogle Scholar
  • 32 Forster KE, Wills A, Torrington AM. et al. Complications and owner assessment of canine total hip replacement: a multicenter internet based survey. Vet Surg 2012; 41: 545-550.
    CrossrefPubMedGoogle Scholar
  • 33 Alt V, Bechert T, Steinrucke P. et al. An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement. Biomaterials 2004; 25: 4383-4391.
    CrossrefPubMedGoogle Scholar
  • 34 Alt V, Bechert T, Steinrucke P. et al. In vitro testing of antimicrobial activity of bone cement. Antimicrob Agents Chemother 2004; 48: 4084-4088.
    CrossrefPubMedGoogle Scholar
  • 35 Oei JD, Zhao WW, Chu L. et al. Antimicrobial acrylic materials with in situ generated silver nanoparticles. J Biomed Mater Res B Appl Biomater 2012; 100: 409-415.
    PubMedGoogle Scholar
  • 36 Sodagar A, Kassaee MZ, Akhavan A. et al. Effect of silver nano particles on flexural strength of acrylic resins. J Prosthodont Res 2012; 56: 120-124.
    CrossrefPubMedGoogle Scholar
  • 37 Ewald A, Hosel D, Patel S. et al. Silver-doped calcium phosphate cements with antimicrobial activity. Acta Biomater 2011; 7: 4064-4070.
    CrossrefPubMedGoogle Scholar
  • 38 Thornes B, Murray P, Bouchier-Hayes D. Development of resistant strains of Staphylococcus epidermidis on gentamicin-loaded bone cement in vivo. J Bone Joint Surg Br 2002; 84: 758-760.
    CrossrefPubMedGoogle Scholar
  • 39 Kim J, Pitts B, Stewart PS. et al. Comparison of the antimicrobial effects of chlorine, silver ion, and tobramycin on biofilm. Antimicrob Agents Chemother 2008; 52: 1446-1453.
    CrossrefPubMedGoogle Scholar
  • 40 Braydich-Stolle L, Hussain S, Schlager JJ. et al. In vitro cytotoxicity of nanoparticles in mammalian germline stem cells. Toxicol Sci 2005; 88: 412-419.
    CrossrefPubMedGoogle Scholar
  • 41 Morrison S, Singh A, Rousseau J. et al. Impact of polymethylmethacrylate on methicillin-resistant Staphylococcus pseudintermedius biofilm formation in vitro. Am J Vet Res 2015; 76: 395-401.
    CrossrefPubMedGoogle Scholar
  • 42 Moojen DJ, Vogely HC, Fleer A. et al. No efficacy of silver bone cement in the prevention of methicillin-sensitive staphylococcal infections in a rabbit contaminated implant bed model. J Orthop Res 2009; 27: 1002-1007.
    CrossrefPubMedGoogle Scholar
  • 43 Swanner J, Mims J, Carroll DL. et al. Differential cytotoxic and radiosensitizing effects of silver nanoparticles on triple-negative breast cancer and non-triple-negative breast cells. Int J Nanomedicine 2015; 10: 3937-3953.
    PubMedGoogle Scholar
  • 44 Kumar R, Munstedt H. Silver ion release from antimicrobial polyamide/silver composites. Biomaterials 2005; 26: 2081-2088.
    CrossrefPubMedGoogle Scholar