Skip to main content

Advertisement

SpringerLink
Log in

Role of bacterial colonisation of vancomycin–gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis.

Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication.

Methods

A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories:

  1. A.

    Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples.

  2. B.

    Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples.

  3. C.

    Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples.

Results

A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%.

Spacers were colonised in all cases by low virulent micro-organisms.

Conclusion

In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Sadoghi P, Liebensteiner M, Agreiter M, Leithner A, Böhler N, Labek G (2013) Revision surgery after total joint arthroplasty: a complication-based analysis using worldwide arthroplasty registers. J Arthroplasty 28(8):1329–1332. https://doi.org/10.1016/j.arth.2013.01.012

  2. Bozic KJ, Kamath AF, Ong K, Lau E, Kurtz S, Chan V, Vail TP, Rubash H, Berry DJ (2015) Comparative epidemiology of revision arthroplasty: failed THA poses greater clinical and economic burdens than failed TKA. Clin Orthop Relat Res 473(6):2131–2138. https://doi.org/10.1007/s11999-014-4078-8

    Article  PubMed  Google Scholar 

  3. Postler A, Lützner C, Beyer F, Tille E, Lützner J (2018) Analysis of total knee arthroplasty revision causes. BMC Musculoskelet Disord 19(1):55. https://doi.org/10.1186/s12891-018-1977-y

    Article  PubMed  PubMed Central  Google Scholar 

  4. Boelch SP, Jakuscheit A, Doerries S, Fraissler L, Hoberg M, Arnholdt J, Rudert M (2018) Periprosthetic infection is the major indication for TKA revision–experiences from a university referral arthroplasty center. BMC Musculoskelet Disord 19(1):395. https://doi.org/10.1186/s12891-018-2314-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA (2017) Current epidemiology of revision total knee arthroplasty in the United States. J Arthroplasty 32(9):2663–2668. https://doi.org/10.1016/j.arth.2017.03.066

    Article  PubMed  Google Scholar 

  6. Anagnostakos K, Fürst O, Kelm J (2006) Antibiotic-impregnated PMMA hip spacers: current status. Acta Orthop 77(4):628–637. https://doi.org/10.1080/17453670610012719.

  7. Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89(4):871–882 https://doi.org/10.2106/JBJS.E.01070.

  8. Kurd MF, Ghanem E, Steinbrecher J, Parvizi J (2010) Two-stage exchange knee arthroplasty: does resistance of the infecting organism influence the outcome? Clin Orthop 468:2060–2066. https://doi.org/10.1007/s11999-010-1296-6

    Article  PubMed  PubMed Central  Google Scholar 

  9. Biring GS, Kostamo T, Garbuz DS, Masri BA, Duncan CP (2009) Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study. J Bone Joint Surg Br 91(11):1431–1437. https://doi.org/10.1302/0301-620X.91B11.22026

    Article  CAS  PubMed  Google Scholar 

  10. Sorlí L, Puig L, Torres-Claramunt R, González A, Alier A, Knobel H, Salvadó M, Horcajada JP (2012) The relationship between microbiology results in the second of a two-stage Exchange procedure using cement spacers and the outcome after revision total joint replacement for infection. J Bone Joint Surg Br 94-B:249–253 https://doi.org/10.1302/0301-620X.94B2.27779.

  11. Nelson CL, Jones RB, Nathaniel C, Wingert NC, Foltzer M, Bowen TR (2014) Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections. Clin Orthop Relat Res 472:2208–2214. https://doi.org/10.1007/s11999-014-3571-4

    Article  PubMed  PubMed Central  Google Scholar 

  12. Borens O, Baalbaki R, Nussbaumer F, Clauss M, Trampuz A (2011) Sonication of temporary devices (spacers and cement nails) inserted during a two-stage implant exchange in patients with prosthetic joint infection. J Bone Joint Surg Br 93-B [Suppl III]:321

  13. Mariconda M, Ascione T, Balato G, Rotondo R, Smeraglia F, Costa GG, Conte M (2013) Sonication of antibiotic-loaded cement spacers in a two-stage revision protocol for infected joint arthroplasty. BMC Musculoskelet Disord 14:193. https://doi.org/10.1186/1471-2474-14-193

    Article  PubMed  PubMed Central  Google Scholar 

  14. Restrepo C, Schmitt S, Backstein D, Alexander BT, Babic M, D Brause B, Esterhai JL, Good RP, Jørgensen PH, Lee P, Marculescu C, Mella C, Perka C, Eslam Pour A, Rubash HE, Saito T, Suarez R, Townsend R, Remzi Tözün I, Van den Bekerom MPJ (2014) Antibiotic treatment and timing of reimplantation. J Arthroplasty 29(2Suppl):104–147. https://doi.org/10.1016/j.arth.2013.09.047

  15. Ariza J, Cobo J, Baraia-Etxaburu J, Benito N, Bori G, Cabo J, Corona P, Esteban J, Horcajada JP, Lora-Tamayo J, Murillo O, Palomino J, Parra J, Pigrau C, Del Pozo JL, Riera M, Rodríguez D, Sánchez-Somolinos M, Soriano A, Del Toro MD, De la Torre B (2017) Executive summary of management of prosthetic joint infections. Clinical practice guidelines by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). Enferm Infecc Microbiol Clin 35(3):189–195. 1016/j.eimc.2016.08.012

  16. Abblitt WP, Ascione T, Bini S, Bori G, Brekke AC, Chen AF, Courtney PM, Della Valle CJ, Diaz-Ledezma C, Ebied A, Fillingham YJ, Gehrke T, Goswami K, Grammatopoulos G, Marei S, Oliashirazi A, Parvizi J, Polkowski G, Saeed K, Schwartz AJ, Segreti J, Shohat N, Springer BD, Suleiman LI, Swiderek LK, Tan TL, Yan CH, Zeng YR (2019) Hip and Knee Section, Outcomes: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 34(2S):S487–S495. https://doi.org/10.1016/j.arth.2018.09.035.

  17. Pivec R, Naziri Q, Issa K, Banerjee S, Mont MA (2014) Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty 29:553–557. https://doi.org/10.1016/j.arth.2013.07.041

    Article  PubMed  Google Scholar 

  18. Esteban J, Gadea I, Pérez-Jorge C, Sandoval E, García-Cañete J, Fernandez-Roblas R, Blanco A, Prieto-Borja L, Cordero-Ampuero J (2016) Diagnosis of spacer-associated infection using quantitative cultures from sonicated antibiotics-loaded spacers: implications for the clinical outcome. Eur J Clin Microbiol Infect Dis 35:207–213. https://doi.org/10.1007/s10096-015-2531-6

    Article  CAS  PubMed  Google Scholar 

  19. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 357:654–663. https://doi.org/10.1056/NEJMoa061588

    Article  CAS  PubMed  Google Scholar 

  20. Rothenberg AC, Wilson AE, Hayes JP, O’Malley MJ, Klatt BA (2017) Sonication of arthroplasty implants improves accuracy of periprosthetic joint infection cultures. Clin Orthop Relat Res 475:1827–1836. https://doi.org/10.1007/s11999-017-5315-8

    Article  PubMed  PubMed Central  Google Scholar 

  21. Olsen AS, Wilson A, O’Malley MJ, Urish KI, Klatt BA (2018) Are Sonication cultures of antibiotic cement spacer useful during second-stage reimplantation surgery for prosthetic joint infection? Clin Orthop Relat Res 476(10):1986–1992. https://doi.org/10.1007/s11999.0000000000000257

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sambri A, Maso A, Storni E, Donati ME, Pederzoli A, Dallari D, Bianchi G, Donati DM (2019) Is sonication of antibiotic-loaded cement spacers useful in two-stage revision of prosthetic joint infection? J Microbiol Methods 156:81–84. https://doi.org/10.1016/j.mimet.2018.12.006

    Article  CAS  PubMed  Google Scholar 

  23. Gomez-Urena E, Sierra RJ, Greenwood-Quiantance KE, Karau MJ, Steckelberg JM, Patel R (2019) Sonication culture of antimicrobial agent-containing cement spacers removed during staged revisions for arthroplasty infection. J Clin Microbiol 57(2):e01483-e1518. https://doi.org/10.1128/JCM.01483-18

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mariaux S, Tafin UF, Borens O (2018) Diagnosis of persistent infection in prosthetic two-stage exchange: evaluation of the effect of sonication on antibiotic release from bone cement spacers. J Bone Joint Infect 3:37–42. https://doi.org/10.7150/jbji.23668

    Article  Google Scholar 

  25. Mariaux S, Tafin UF, Borens O (2017) Diagnosis of persistent infection in prosthetic two-stage exchange: PCR analysis of sonication fluid from bone cement spacers. J Bone Joint Infect 2(4):218–223

    Article  Google Scholar 

  26. Wouthuyzen-Bakker M, Kheir M, Moya I, Rondon A, Kheir M, Lozano L, Parvizi J, Soriano A (2019) Failure after 2-stage exchange arthroplasty for treatment of periprosthetic joint infection: The role of antibiotics in the cement spacer. Clin Infect Dis 68(12):2087–2093. https://doi.org/10.1093/cid/ciy851

    Article  PubMed  Google Scholar 

  27. Corró S, Vicente M, Rodríguez-Pardo D, Pigrau C, Lung M, Corona PS (2020) Vancomycin-Gentamicin prefabricated spacers in 2-stage revision arthroplasty for chronic hip and knee periprosthetic joint infection: insights into reimplantation microbiology and outcomes. J Arthroplasty 35(1):247–254. https://doi.org/10.1016/j.arth.2019.07.043

    Article  PubMed  Google Scholar 

  28. Zmistowski B, Tetreault MW, Alijanipour P, Chen AF, Della Valle CJ, Parvizi J (2013) Recurrent periprosthetic joint infection: persistent or new infection? J Arthroplasty 28:1486–1489. https://doi.org/10.1016/j.arth.2013.02.02

    Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organisation for the submitted work.

Author information

Authors and Affiliations

  1. Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain

    Sandra Huguet, Martí Bernaus & Lluís Font-Vizcarra

  2. Department of Traumatology and Orthopaedics, Consorci Sanitari de l’Alt Penedès - Garraf, Barcelona, Spain

    Sandra Huguet

  3. Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain

    Martí Bernaus, Lucía Gómez, Eva Cuchí & Lluís Font-Vizcarra

  4. Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain

    Lucía Gómez

  5. Department of Microbiology, CATLAB, Viladecavalls, Barcelona, Spain

    Eva Cuchí

  6. Department of Infectious Diseases – Osteoarticular Infections Unit, Hospital Clínic, Barcelona, Spain

    Alex Soriano

Authors
  1. Sandra Huguet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martí Bernaus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucía Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eva Cuchí
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alex Soriano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Lluís Font-Vizcarra
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

The manuscript was written by Sandra Huguet, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sandra Huguet.

Ethics declarations

Conflict of interest

The authors have no relevant financial or nonfinancial interests to disclose.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Fundació Assistencial Mútua Terrassa in view of the retrospective nature of the study, and all the procedures being performed were part of the routine care.

Consent to publish/Consent to participate

No written consent was needed for this article. No identifying information is included in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huguet, S., Bernaus, M., Gómez, L. et al. Role of bacterial colonisation of vancomycin–gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. Eur J Orthop Surg Traumatol 32, 1661–1669 (2022). https://doi.org/10.1007/s00590-021-03151-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-021-03151-5

Keywords

Search

Navigation