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The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections

Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospective...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2016-10, Vol.24 (10), p.3122-3130
Main Authors: Drexler, Michael, Dwyer, Tim, Kuzyk, Paul R. T., Kosashvilli, Yona, Abolghasemian, Mansour, Regev, Gilad J., Kadar, Assaf, Rutenberg, Tal Frenkel, Backstein, David
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cited_by cdi_FETCH-LOGICAL-c405t-80e2169acae8349515ba8e7e89264b50eb668cc870f71100b7e2e469c1696c1a3
cites cdi_FETCH-LOGICAL-c405t-80e2169acae8349515ba8e7e89264b50eb668cc870f71100b7e2e469c1696c1a3
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container_title Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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creator Drexler, Michael
Dwyer, Tim
Kuzyk, Paul R. T.
Kosashvilli, Yona
Abolghasemian, Mansour
Regev, Gilad J.
Kadar, Assaf
Rutenberg, Tal Frenkel
Backstein, David
description Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought. Results The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision ( p  
doi_str_mv 10.1007/s00167-015-3753-y
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T. ; Kosashvilli, Yona ; Abolghasemian, Mansour ; Regev, Gilad J. ; Kadar, Assaf ; Rutenberg, Tal Frenkel ; Backstein, David</creator><creatorcontrib>Drexler, Michael ; Dwyer, Tim ; Kuzyk, Paul R. T. ; Kosashvilli, Yona ; Abolghasemian, Mansour ; Regev, Gilad J. ; Kadar, Assaf ; Rutenberg, Tal Frenkel ; Backstein, David</creatorcontrib><description>Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought. Results The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision ( p  &lt; 0.01), polymicrobial infections ( p  = 0.035), and infections presenting &lt;6 months after index surgery ( p  = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index. Conclusion The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-015-3753-y</identifier><identifier>PMID: 26272061</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anti-Bacterial Agents - administration &amp; dosage ; Antibiotics ; Arthroplasty, Replacement, Knee - adverse effects ; Bacteria ; Bone Cements ; Ceftazidime - administration &amp; dosage ; Female ; Gram-negative bacteria ; Humans ; Infections ; Joint replacement surgery ; Knee ; Knee Prosthesis - adverse effects ; Male ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Orthopedics ; Patients ; Polymethyl methacrylate ; Prosthesis-Related Infections - classification ; Prosthesis-Related Infections - microbiology ; Prosthesis-Related Infections - therapy ; Reoperation - methods ; Retrospective Studies ; Success ; Transplants &amp; implants ; Vancomycin - administration &amp; dosage</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2016-10, Vol.24 (10), p.3122-3130</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c405t-80e2169acae8349515ba8e7e89264b50eb668cc870f71100b7e2e469c1696c1a3</citedby><cites>FETCH-LOGICAL-c405t-80e2169acae8349515ba8e7e89264b50eb668cc870f71100b7e2e469c1696c1a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26272061$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Drexler, Michael</creatorcontrib><creatorcontrib>Dwyer, Tim</creatorcontrib><creatorcontrib>Kuzyk, Paul R. T.</creatorcontrib><creatorcontrib>Kosashvilli, Yona</creatorcontrib><creatorcontrib>Abolghasemian, Mansour</creatorcontrib><creatorcontrib>Regev, Gilad J.</creatorcontrib><creatorcontrib>Kadar, Assaf</creatorcontrib><creatorcontrib>Rutenberg, Tal Frenkel</creatorcontrib><creatorcontrib>Backstein, David</creatorcontrib><title>The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought. Results The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision ( p  &lt; 0.01), polymicrobial infections ( p  = 0.035), and infections presenting &lt;6 months after index surgery ( p  = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index. 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T.</au><au>Kosashvilli, Yona</au><au>Abolghasemian, Mansour</au><au>Regev, Gilad J.</au><au>Kadar, Assaf</au><au>Rutenberg, Tal Frenkel</au><au>Backstein, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>24</volume><issue>10</issue><spage>3122</spage><epage>3130</epage><pages>3122-3130</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose This study examined the success and factors associated with failure, of using cement spacers impregnated with high-dose Ceftazidime and Vancomycin when performing two-stage revision for infected total knee arthroplasty (TKA). Methods A retrospective analysis was performed using a prospectively collected database of 82 patients (median age 68 years, range 39–87) with a confirmed deep TKA infection treated with a two-stage revision. All cement spacers were impregnated with high-dose Ceftazidime and Vancomycin. The rate of success was recorded—an association between failure of treatment, and patient factors, previous surgical treatment, and microbial characteristics was sought. Results The mean time to infection from index arthroplasty was 45 months (range 3–240). The initial two-stage revision was successful in 70/82 patients (85.4 %), who remained free of infection at average follow-up of 36.2 months (range 24–85). A second two-stage revision for infection was required in 12/82 patients (14.6 %), which was successful in 4/12 (33 %). A third two-stage revision was performed in three patients, all of whom had a polymicrobial infection of which only one patient had successful eradication of infection. Recurrent infection was correlated with irrigation and debridement with implant retention prior to initial two-stage revision ( p  &lt; 0.01), polymicrobial infections ( p  = 0.035), and infections presenting &lt;6 months after index surgery ( p  = 0.031). No correlation was seen with age, BMI, type of organism, diabetes mellitus, or Charlson Comorbidity Index. Conclusion The findings of this study suggest that the combination of Ceftazidime and Vancomycin in cement spacers is as efficacious as other published single or combined antibiotic mixtures, which is clinically relevant to clinicians treating this difficult problem in the setting of patients with compromised renal function.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>26272061</pmid><doi>10.1007/s00167-015-3753-y</doi><tpages>9</tpages></addata></record>
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source EBSCOhost SPORTDiscus with Full Text; Wiley-Blackwell Read & Publish Collection; Springer Link
subjects Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - administration & dosage
Antibiotics
Arthroplasty, Replacement, Knee - adverse effects
Bacteria
Bone Cements
Ceftazidime - administration & dosage
Female
Gram-negative bacteria
Humans
Infections
Joint replacement surgery
Knee
Knee Prosthesis - adverse effects
Male
Medicine
Medicine & Public Health
Middle Aged
Orthopedics
Patients
Polymethyl methacrylate
Prosthesis-Related Infections - classification
Prosthesis-Related Infections - microbiology
Prosthesis-Related Infections - therapy
Reoperation - methods
Retrospective Studies
Success
Transplants & implants
Vancomycin - administration & dosage
title The results of two-stage revision TKA using Ceftazidime–Vancomycin-impregnated cement articulating spacers in Tsukayama Type II periprosthetic joint infections
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