Antibiotic-impregnated Cement Spacers for the Treatment of Periprosthetic Joint Infection

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Kongkit Pithankuakul, MD


The common treatment of chronic infection from periprosthetic joint infection is two-stage revision arthroplasty. The first-stage revision will use an antibiotic-impregnated cement spacer to maintain alignment, prevent soft tissue contracture, and produce high local drug concentration. An inadequate of antibiotic elution may cause drug resistance. There are many factors that influence the elution of antibiotic from the bone cement spacer including the type of antibiotic used, the amount of antibiotic, the type of bone cement, the porosity of bone cement, and the mixing method. The preparation of a proper and effective antibiotic-impregnated  cement  spacer  can  help the treatment of periprosthetic joint infection to be successful.


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Pithankuakul K. Antibiotic-impregnated Cement Spacers for the Treatment of Periprosthetic Joint Infection. BKK Med J [Internet]. 2015 Feb. 20 [cited 2023 Dec. 2];9(1):67. Available from:
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1. Cui Q, Mihalko WM, Shields JS, et al. Antibiotic- impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 2007;89:871-82.
2. Parvizi J, Adeli B, Zmistowski B, et al. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection. J Bone Joint Surg Am 2012; 94:e104.
3. Insall JN, Thompson FM, Brause BD. Two-stage reim- plantation for the salvage of infected total knee arthro- plasty. J Bone Joint Surg Am 1983;65:1087-98.
4. Jaeblon T. Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J Am Acad Orthop Surg 2010;18:297-305.
5. Buchholz HW. Management of deep infection of total hip replacement. J Bone Joint Surg Br 1981;63B:342-53.
6. Hanssen AD, Spangehl MJ. Practical applications of antibiotic loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res 2004;427:79-85.
7. Jiranek W. Antibiotic-loaded cement in total hip replace- ment: current indications, efficacy, and complications. Orthopedics 2005;28(8 Suppl):s873-7.
8. del Real RP, Padilla S. Vallet-Regi M. Gentamicin releasefromhydroxyapatite/poly(ethyl methacrylatet/poly (methyl methacrylatejcomposites. J Biomed Mater Res 2000;52:1-7.
9. Adams K, Couch L, Cierny G, et al. In vitro and in vivo evaluation of antibiotic diffusion from antibiotic-im- pregnated polymethylmethacrylate beads. Clin Orthop Relat Res 1992;278:244-52.
10. Brien WW, Salvati EA, Klein R, et al. Antibiotic impreg- nated bone cement in total hip arthroplasty. An in vivo comparison of the elution properties of tobramycin and vancomycin. Clin Orthop Relat Res 1993;296:242-8.
11. Lautenschlager EP, Jacobs JJ, Marshall GW, et al. Me- chanical properties of bone cements containing large doses of antibiotic powders. J Biomed Mater Res 1976; 10:929-38.
12. Springer BD, Lee GC, Osmon D, et al. Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res 2004;427:47-51.
13. McLaren AC, McLaren SG, Hickmon MK. Sucrose, xylitol, and erythritol increase PMMA permeability for depot antibiotics. Clin Orthop Relat Res 2007;461:60-3.
14. McLaren AC, Nelson CL, McLaren SG, et al. The effect of glycine filler on the elution rate of gentamicin from acrylic bone cement: a pilot study. Clin Orthop Relat Res 2004;427:25-7.
15. Kuechle DK, Landon GC, Musher DM, et al. Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement. Clin Orthop Relat Res 1991;264:302-8.
16. Shiramizu K, Lovric V, Leung A, et al. How do porosity- inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer. J Orthop Traumatol 2008;9:17-22.
17. Lewis G. Properties of acrylic bone cement: state of the art review. J Biomed Mater Res 1997;38:155-82.
18. Macaulay W, DiGiovanni CW, Restrepo A, et al. Differences in bone-cement porosity by vacuum mixing,centrifugation, and hand mixing. J Arthroplasty 2002;17:569-75.
19. Amin TJ, Lamping JW, Hendricks KJ, et al. Increasing the elution of vancomycin from high-dose antibiotic- loaded bone cement: a novel preparation technique. J Bone Joint Surg Am 2012;94:1946-51.
20. Duncan CP, Masri BA. The role of antibiotic-loaded cement in the treatment of an infection after a hip replacement. Instr Course Lect 1995; 44:305-13.
21. van Raaij TM, Visser LE, Vulto AG, Ver haar JA. Acute renal failure after local gentamicin treatment in an infected total knee arthroplasty. J Arthroplasty 2002; 17:948-50
22. Isefuku S, Joyner CJ, Simpson AH. Gentamicin may have an adverse effect on osteogenesis. J Orthop Trauma 2003;17:212-6.