Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement

Bong-Ju Park; Hong-Man Cho; Ju-Hyun Sim; Hyun-Ju Choi

doi:10.5371/jkhs.2011.23.4.310

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Park, Cho, Sim, and Choi: Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement

Original Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(4): 310-317.

Published online: 31 December 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.4.310

Treatment of Infected Hip Arthroplasty with Antibiotic-Impregnated Calcium Sulfate Cement

Bong-Ju Park, MD, Hong-Man Cho, MD, Ju-Hyun Sim, MD, Hyun-Ju Choi, MD^*

Department of Orthopedic Surgery, Gwangju Veterans Hospital, Gwangju, Korea.

^*Department of Internal Medicine, Hankook Hospital, Daejeon, Korea.

Address reprint request to Hong-Man Cho, MD. Department of Orthopedic Surgery, Gwangju Veterans Hospital, 887-1 Sanwol-dong, Gwangsan-gu, Gwangju 506-705, Korea. TEL: +82-62-602-6162, FAX: +82-62-602-6164, chm1228@hanmail.net

Received 8 March 2011 Revised 2 December 2011 Accepted 6 December 2011

Abstract

Purpose

To analyze the effectiveness of inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin after debridement of an acute-immediate stage infected hip arthroplasty.

Materials and Methods

Between 2002 and 2008, the cases of 13 patients with documented acute-immediate stage infections of hip arthroplasty were reviewed and followed for at least two years postoperatively (average 4.3 years). The preoperative and postoperative clinical and radiologic findings and blood laboratory work of the cases were checked. All cases were performed through retention of the implant and massive debridement and saline irrigation. Next, vancomycin-impregnated calcium sulfate cement beads were inserted.

Results

After the first operation, the average interval to wait before performing a second operation was 27.7 days (17~37 days). During the second operation, the erythrocyte sediment rate and C-reactive protein were 150.97 mm/hr (34.6~339.7 mm/hr) and 76.4 mg/L (41~132 mg/L), respectively. Infectious organisms were cultured and isolated. There were 5 cases of Methicillin-resistant Staphylococcus aureus (MRSA). In addition, the results of an antibiotics sensitivity test revealed 8 cases of Vancomycin and 5 cases of 3rd generation Cephalosporin. Radiologic results showed 10 cases with a stable fixation on the last follow-up (femoral stem), and 1 case of hip joint space narrowing, called acetabular erosion.

Conclusion

Inserting beads made of calcium sulfate cement that were also impregnated with Vancomycin proved to be a useful treatment for an acute immediate infection of hip arthroplasty.

Keywords: Infection, Calcium sulfate, Cement bead

Figures and Tables

Fig. 1

(A) Vancomycin impregnated calcium sulfate cement bead. (B) Postoperative radiograph showed calcium sulfate cement bead insertion state after debridement and irrigation.

Fig. 2

(A) Radiograph at 3 weeks after bead insertion showing partially degradation of the calcium sulfate bead. (B) Radiograph at 5 weeks after bead insertion showing fully degradation of the calcium sulfate bead.

Table 1

Summary of Cases

^*Dx & Op: Diagnosis and primany operation, ^†ESR: Erythrocyte Sedimentation Rate, ^‡CRP: C-reactive protein

^§Interval: Time from primary operation to second operation, ^∥FNF: Femur neck fracture, ^¶BHA : Bipolar Hemiarthroplasty

^**AVN: Avascular Necrosis of femoral head, ^††THA: Total Hip Arthroplasty

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