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DOI: 10.3415/VCOT-16-01-0004
One-stage revision of an infected cementless total hip replacement
Publication History
Received:
11 January 2016
Accepted:
26 July 2016
Publication Date:
19 December 2017 (online)
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.
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References
- 1 Conzemius MG, Vandervoort J. Total joint replacement in the dog. Vet Clin North Am Small Anim Pract 2005; 35: 1213-1231.
- 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.
- 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.
- 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.
- 5 Schulz KS. Application of arthroplasty principles to canine cemented total hip replacement. Vet Surg 2000; 29: 578-593.
- 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.
- 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.
- 8 Torres BT, Budsberg SC. Revision of cemented total hip arthroplasty with cementless components in three dogs. Vet Surg 2009; 38: 81-86.
- 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.
- 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.
- 11 Romano CL, Romano D, Logoluso N. et al. Septic versus aseptic total hip revision: how different?. J Orthop Traumatol 2010; 11: 167-174.
- 12 Vielpeau C, Lortat-Jacob A, Coll A. Management of the infected hip prostheses. Rev Chir Orthop 2002; 88 (Suppl. 01) 159-216.
- 13 Muñoz-Mahamud E, Gallart X, Soriano A. One-stage revision arthroplasty for infected hip replacements. Open Orthop J 2013; 7: 184-189.
- 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.
- 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.
- 16 Dyce J, Olmstead ML. Removal of infected canine cemented total hip prostheses using a femoral window technique. Vet Surg 2002; 31: 552-560.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 37 Ewald A, Hosel D, Patel S. et al. Silver-doped calcium phosphate cements with antimicrobial activity. Acta Biomater 2011; 7: 4064-4070.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 44 Kumar R, Munstedt H. Silver ion release from antimicrobial polyamide/silver composites. Biomaterials 2005; 26: 2081-2088.