Abstract
Background
Two-stage revision arthroplasty is a widely used treatment method for infected knee
arthroplasty. Loading high doses of antibiotics to spacer during the first stage is
standard practice. However, there are reported systemic side effects attributed to
antibiotic-loaded spacers. The aim of our study is to investigate the success rate
and systemic toxicity following the first stage revision knee arthroplasty with low-dose
vancomycin-loaded spacers.
Method
We included patients with infected knee arthroplasty eligible for two-stage revision
arthroplasty from 2001 to 2020. One gram of vancomycin is added per pack of bone cement.
Spacers were handmade in the operating theatre. Following the first stage, pre-operative
and postoperative culture results, infection parameters, kidney and liver function
tests, and functional scores were analyzed. Kaplan-Meier survival analysis was done
to determine the success rate.
Results
Fifty patients with a mean follow-up of 48 months (24–108) were included in the study.
A five-year survival analysis showed an 88.5% success rate. Fourteen percent of the
patients had acute kidney injury with creatinine levels between 1.12–2.80 mg/dl, and
8% had a mild drug-induced liver injury with elevated serum ALT levels between 223–540
U/L and total bilirubin levels between 0.59–1.23 mg/dl. None of the patients required
dialysis. All of the systemic side effects were reversible.
Conclusion
Our results have suggested that low dose antibiotic-loaded spacers are comparable
to the studies with high dose antibiotic loaded spacers regarding infection eradication
and survival rates. They are less likely to cause severe systemic side effects. Therefore
we suggest low dose antibiotic-loaded spacers should be considered when treating patients
with vancomycin sensitive Staphylococcal species and culture negative infected knee
arthroplasty.
Keywords
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Article info
Publication history
Published online: November 18, 2022
Accepted:
November 3,
2022
Received in revised form:
September 22,
2022
Received:
March 2,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
