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Review

Antibiotic-loaded cement spacers – lessons learned from the past 20 years

&
Pages 231-245 | Received 07 Oct 2017, Accepted 29 Jan 2018, Published online: 02 Feb 2018

References

  • Anagnostakos K Therapeutic use of antibiotic-loaded bone cement in the treatment of hip and knee joint infections. J Bone Joint Infect. 2017;2:29–37
  • Anagnostakos K, Fürst O, Antibiotic-Impregnated KJ PMMA hip spacers: current status. Acta Orthop. 2006;77:628–637
  • 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;89:871–882
  • Hsieh PH, Chang YH, Chen SH, et al. Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture. Int Orthop. 2006;30:228–232
  • Kelm J, Bohrer P, Schmitt E, et al. Treatment of proximal femur infections with antibiotic-loaded cement spacers. Int J Med Sci. 2009;6:258–264
  • Romano CL, Romano D, Meani E, et al. Two-stage revision surgery with preformed spacers and cementless implants for septic hip arthritis: a prospective, non-randomized cohort study. BMC Infect Dis. 2011;11:129
  • Anagnostakos K, Duchow L, Koch K Two-stage protocol and spacer implantation in the treatment of destructive septic arthritis of the hip joint. Arch Orthop Trauma Surg. 2016;136:899–906
  • Faroug R, Shah Y, McCarthy MJ, et al. Two stage one component revision in infected total hip replacements – two case reports and literature review. Hip Int. 2009;19:292–298
  • Anagnostakos K, Jung J, Kelm J, et al. Two-stage treatment protocol for isolated septic acetabular cup loosening. Hip Int. 2010;20:320–326
  • Lee YK, Lee KH, Nho JH, et al. Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Acta Orthop. 2013;84:260–264
  • Chen KH, Tsai SW, Wu PK, et al. Partial component-retained two-stage reconstruction for chronic infection after uncemented total hip arthroplasty: results of sixteen cases after five years of follow-up. Int Orthop. 2017;41:2479-2486.
  • Ekpo TE, Berend KR, Morris MJ, et al. Partial two-stage exchange of infected total hip arthroplasty: a preliminary report. Clin Orthop Relat Res. 2014;472:437–448
  • Lombardi AV Jr, Berend KR, Adams JB Partial two-stage exchange of the infected total hip replacement using disposable spacer moulds. Bone Joint J. 2014;96:66–69
  • Kuzyk PR, Dhotar HS, Sternheim A, et al. Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg. 2014;22:153–164
  • Pivec R, Naziri Q, Issa K, et al. Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty. 2014;29:553–557
  • Voleti PB, Baldwin KD, Lee GC Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review. J Bone Joint Surg Am. 2013;95:1594–1599
  • Buchholz HW, Engelbrecht H Depots effects of various antibiotics mixed with Palacos resins. Chirurg. 1970;41:511–515
  • Anagnostakos K, Kelm J Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater. 2009;90:467–475
  • Bayston R, Milner RDG The sustained release of antimicrobial drugs from bone cement: an appraisal of laboratory investigations and their significance. J Bone Joint Surg Br. 1982;64:460–464
  • Law HAT, Fleming RH, Gilmore MFX, et al. In vitro measurement and computer modelling of the diffusion of antibiotic in bone cement. J Biomed Eng. 1986;8:149–155
  • Wahlig H, Dingeldein E Antibiotics and bone cements: experimental and clinical long-term observations. Acta Orthop Scand. 1980;51:49–56
  • Baker AS, Greenham LW Release of gentamicin from acrylic bone cement. J Bone Joint Surg Am. 1988;70:1551–1557
  • Kuechle DK, Landon GC, Musher DM, et al. Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement. Clin Orthop Relat Res. 1991;264:302–308
  • Schurman DJ, Trindade C, Hirshman HP, et al. Antibiotic-acrylic bone cement composites: studies of gentamycin and palaces. J Bone Joint Surg Am. 1978;64:978–984
  • Wroblewski BM Leaching out from acrylic bone cement: experimental evaluation. Clin Orthop Relat Res. 1977;124:311–312
  • Van De Belt H, Neut D, Uges D, et al. Surface roughness, porosity and wettability of gentamicin-loaded bone cements and their antibiotic release. Biomaterials. 2000;21:1981–1987
  • Wahlig H Über die Freisetzungskinetik von Antibiotika aus Knochenzementen – ergebnisse vergleichender Untersuchungen in vitro und in vivo. Aktuelle Probl Chir Orthop. 1987;31:221–226
  • Penner MJ, Duncan CP, Masri BA The in vitro elution characteristics of antibiotic-loaded CMW and Palacos-R bone cements. J Arthroplasty. 1999;14:209–214
  • Neut D, Van De Belt H, Van Horn JR, et al. The effect of mixing on gentamicin release from polymethylmethacrylate bone cements. Acta Orthop Scand. 2003;74:670–676
  • Simpson PM, Dall GF, Breusch SJ, et al. In vitro elution and mechanical properties of antibiotic-loaded SmartSet HV and Palacos R acrylic bone cements. Orthopäde. 2005;34:1255–1262
  • Cerretani D, Giorgi G, Fornara P, et al. The in vitro elution characteristics of vancomycin combined with imipenem-cilastatin in acrylic bone cements. J Arthroplasty. 2002;17:619–626
  • Neut D, De Groot EP, Kowalski RSZ, et al. Gentamicin-loaded bone cement with clindamycin or fusidic acid added: biofilm formation and antibiotic release. J Biomed Mater Res A. 2005;73:165–170
  • Mau H, Schelling K, Heisel C, et al. Comparison of various vacuum mixing systems and bone cements as regards reliability, porosity and bending strength. Acta Orthop Scand. 2004;75:160–172
  • Masri BA, Kendall RW, Duncan CP, et al. Two-stage exchange arthroplasty using a functional antibiotic-loaded spacer in the treatment of the infected knee replacement: the Vancouver experience. Semin Arthroplasty. 1994;5:122–136
  • Anagnostakos K, Köhler D, Schmitt E, et al. The “glove” technique: a modified method for femoral fixation of antibiotic-loaded hip spacers. Acta Orthop. 2009;80:386–388
  • Barrack RL Rush pin technique for temporary antibiotic impregnated cement prosthesis for infected total hip arthroplasty. J Arthroplasty. 2002;17:600–603
  • Ries MD, Jergesen H An inexpensive molding method for antibiotic-impregnated cement spacers in infected total hip arthroplasty. J Arthroplasty. 1999;14:764–765
  • Shin SS, Della Valle CJ, Ong BC, et al. A simple method for construction of an articulating antibiotic loaded cement spacer. J Arthroplasty. 2002;17:785–787
  • Fink B Revision of late periprosthetic infections of total hip endoprostheses: pros and cons of different concepts. Int J Med Sci. 2009;6:287–295
  • Durbhakula SM, Czajka J, Fuchs MD, et al. Antibiotic-loaded articulating cement spacer in the 2-stage exchange of infected total knee arthroplasty. J Arthroplasty. 2004;19:768–774
  • Hsu YC, Cheng HC, Ng TP, et al. Antibiotic-loaded cement articulating spacer for 2-stage reimplantation in infected total knee arthroplasty: a simple and economic method. J Arthroplasty. 2007;22:1060–1066
  • Shaikh AA, Ha CW, Park YG, et al. Two-stage approach to primary TKA in infected arthritic knees using intraoperatively molded articulating cement spacers. Clin Orthop Relat Res. 2014;472:2201–2207
  • Marothi DP, Sharma V, Sheth AN, et al. Management of infected total knee arthroplasty by a new innovative customized articulating knee spacer: an early experience. J Orthop Case Rep. 2016;6:20–22
  • Coe PO, Jain NP, Johnson DS Custom fitted articulating cement spacers for use in two-stage revision knee replacement. Ann R Coll Surg Engl. 2014;96:624–625
  • Classen T, Von Knoch M, Wernsmann M, et al. Functional interest of an articulating spacer in two-stage infected total knee arthroplasty revision. Orthop Traumatol Surg Res. 2014;100:409–412
  • Nettrour JF, Polikandriotis JA, Bernasek TL, et al. Articulating spacers for the treatment of infected total knee arthroplasty: effect of antibiotic combinations and concentrations. Orthopedics. 2013;36:e19–24
  • Chen YP, Wu CC, Ho WP Autoclaved metal-on-cement spacer versus static spacer in two-stage revision in periprosthetic knee infection. Indian J Orthop. 2016;50:146–153
  • Juul R, Fabrin J, Poulsen K, et al. Use of a new knee prosthesis as an articulating spacer in two-stage revision of infected total knee arthroplasty. Knee Surg Relat Res. 2016;28:239–244
  • Lyons ST, Wright CA, Krute CN, et al. Confirming sterility of an autoclaved infected femoral component for use in an articulated antibiotic knee spacer: a pilot study. J Arthroplasty. 2016;31:245–249
  • Kim YS, Bae KC, Cho CH, et al. Two-stage revision using a modified articulating spacer in infected total knee arthroplasty. Knee Surg Relat Res. 2013;25:180–185
  • Askew MJ, Kufel MF, Fleissner PR Jr, et al. Effect of vacuum mixing on the mechanical properties of antibiotic-impregnated polymethylmethacrylate bone cement. J Biomed Mater Res. 1990;24:573–580
  • Citak M, Argenson JN, Masri B, et al. Spacers. J Orthop Res. 2014;32:S120–9.
  • Anagnostakos K, Meyer C Antibiotic elution from hip and knee acrylic bone cement spacers: a systematic review. Biomed Res Int. 2017;2017:4657874.
  • Anagnostakos K, Wilmes P, Schmitt E, et al. Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop. 2009;80:193–197
  • Balato G, Ascione T, Rosa D, et al. Release of gentamicin from cement spacers in two-stage procedures for hip and knee prosthetic infection: an in vivo pharmacokinetic study with clinical follow-up. J Biol Regul Homeostc Agents. 2015;29:63–72
  • Bertazzoni Minelli E, Benini A, Samaila E, et al. Antimicrobial activity of gentamicin and vancomycin combination in joint fluids after antibiotic-loaded cement spacer implantation in two-stage revision surgery. J Chemother. 2015;27:17–24
  • Hsieh PH, Chang YH, Ueng SWN, et al. High concentration and bioactivity of vancomycin and aztreonam eluted from simplex cement spacers in two-stage revision of infected hip implants: a study of 46 patients at an average follow up of 107 days. J Orthop Res. 2006;24:1615–1621
  • Hsieh PH, Huang KC, Tai CL Liquid gentamicin in bone cement spacers: in vivo antibiotic release and systemic safety in two-stage revision of infected hip arthroplasty. J Trauma. 2009;66:804–808
  • Regis D, Sandri A, Samaila E, et al. Release of gentamicin and vancomycin from preformed spacers in infected total hip arthroplasties: measurement of concentrations and inhibitory activity in patients’ drainage fluids and serum. Sci World J. 2013;2013:752184
  • Fink B, Vogt S, Reinsch M, et al. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res. 2011;469:3141–3147.
  • Masri BA, Duncan CP, Beauchamp CP Long-term elution of antibiotics from bone-cement: an in vivo study using the prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) system. J Arthroplasty. 1998;13:331–338
  • Mutimer J, Gillespie G, Lovering AM, et al. Measurements of in vivo intra-articular gentamicin levels from antibiotic loaded articulating spacers in revision total knee replacement. Knee. 2009;16:39–41
  • Bertazzoni Minelli E, Benini A, Magnan B, et al. Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. J Antimicrob Chemother. 2004;53:329–334.
  • Kelm J, Regitz T, Schmitt E, et al. In vivo and in vitro studies of antibiotic release from and bacteria growth inhibition by antibiotic-impregnated polymethylmethacrylate hip spacers. Antimicrob Agents Chemother. 2006;50:332–335
  • Jacobs C, Christensen CP, Berend ME Static and mobile antibiotic-impregnated cement spacers for the management of prosthetic joint infection. J Am Acad Orthop Surg. 2009;17:356–368.
  • Guild GN 3rd, Wu B, Scuderi GR. Articulating vs. static antibiotic impregnated spacers in revision total knee arthroplasty for sepsis. A systematic review. J Arthroplasty. 2014;29:558–563.
  • Citak M, Masri BA, Springer B, et al. Are preformed articulating spacers superior to surgeon-made articulating spacers in the treatment of PJI in THA? A literature review. Open Orthop J. 2015;9:255–261.
  • Hsieh PH, Shih CH, Chang YH, et al. Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am. 2004;86:1989–1997
  • Fehring TK, Odum S, Calton TF, et al. Articulating versus static spacers in revision total knee arthroplasty for sepsis. The ranawat award. Clin Orthop Relat Res 2000;380:9–16
  • Kalore NV, Maheshwari A, Sharma A, et al. Is there a preferred articulating spacer technique for infected knee arthroplasty? A preliminary study. Clin Orthop Relat Res. 2012;470:228–235
  • Fink B, Rechtenbach A, Büchner H, et al. Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time. Clin Orthop Relat Res. 2011;469:1095–1102
  • Jung J, Schmid NV, Kelm J, et al. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265–273.
  • Faschingbauer M, Reichel H, Bieger R, et al. Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty. Int Orthop. 2015;39:989–994
  • Fink B, Schlumberger M, Oremek D Single-stage acetabular revision during two-stage THA revision for infection is effective in selected patients. Clin Orthop Relat Res. 2017;475:2063–2070
  • Struelens B, Claes S, Bellemans J Spacer-related problems in two-stage revision knee arthroplasty. Acta Orthop Belg. 2013;79:422–426.
  • Faschingbauer M, Bieger R, Reichel H, et al. Complications associated with 133 static, antibiotic-laden spacers after TKA. Knee Surg Sports Traumatol Arthrosc. 2016;24:3096–3099
  • Castelli CC, Gotti V, Ferrari R Two-stage treatment of infected total knee arthroplasty: two to thirteen year experience using an articulating performed spacer. Int Orthop. 2014;38:405–412
  • Van Thiel GS, Berend KR, Klein GR, et al. Intraoperative molds to create an articulating spacer for the infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:994–1001
  • Johnson AJ, Sayeed SA, Naziri Q, et al. Minimizing dynamic knee spacer complications in infected revision arthroplasty. Clin Orthop Relat Res. 2012;470:220–227
  • 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.
  • Curtis JM, Sternhagen V, Batts D Acute renal failure after placement of tobramycin-impregnated bone cement in an infected total knee arthroplasty. Pharmacotherapy. 2005;25:876–880
  • Dovas S, Liakopoulos V, Papatheodorou L, et al. Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty. Clin Nephrol. 2008;69:207–212
  • Geller JA, Cunn G, Herschmiller T, et al. Acute kidney injury after first-stage joint revision for infection: risk factors and the impact of antibiotic dosing. J Arthroplasty. 2017;32:3120-3125.
  • Luu A, Syed F, Raman G, et al. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity, and infection control. J Arthroplasty. 2013;28:1490–1498
  • Wentworth SJ, Masri BA, Duncan CP, et al. Hip prosthesis of antibiotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty. J Bone Joint Surg Am. 2003;84:123–128
  • Koo KH, Yang JW, Cho SH, et al. Impregnation of vancomycin, gentamicin and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty. 2001;16:882–892
  • Berend KR, Lombardi AV Jr, Morris MJ, et al. Two-stage treatment of hip periprosthetic joint infection is associated with a high rate of infection control but high mortality. Clin Orthop Relat Res. 2013;471:510–518
  • Leung F, Richards CJ, Garbuz DS, et al. Two stage total hip arthroplasty: how often does it control methicillin resistant infection? Clin Orthop Relat Res. 2011;469:1009–1015
  • Toulson C, Walcott-Sapp S, Hur J, et al. Treatment of infected total hip arthroplasty with a 2-stage reimplantation protocol: update on “our institution’s” experience from 1989 to 2003. J Arthroplasty. 2009;24:1051–1060
  • Cancienne JM, Werner BC, Bolarinwa SA, et al. Removal of an infected total hip arthroplasty: risk factors for repeat debridement, long-term spacer retention, and mortality. J Arthroplasty. 2017;32:2519–2522
  • Anagnostakos K, Jung J, Schmid NV, et al. Mechanical complications and reconstruction strategies at the site of hip spacer implantations. Int J Med Sci. 2009;6:274–279
  • Anagnostakos K, Lorbach O, Orth P, et al. A simple technique for adjustment of the femoral offset at the site of hip spacer implantation, J Surg Tech Case Rep. 2013;5:18–20
  • Ben-Lulu O, Farno A, Gross AE, et al. A modified cement spacer technique for infected total hip arthroplasties with significant bone loss. J Arthroplasty. 2012;27:613–619
  • Baker RP, Duncan CP Acyclic acetabular roof reconstruction for severe superior segmental acetabular bone loss in 2-stage surgery for infected hip arthroplasty. J Arthroplasty. 2011;26:1567–1569
  • Barreira P, Leite P, Neves P, et al. Preventing mechanical complications of hip spacer implantation: technical tips and pearls. Acta Orthop Belg. 2015;81:344–348
  • Drexler M, Kuzyk PR, Koo K, et al. The use of a supra-acetabular antibiotic-loaded cement shelf to improve hip stability in first-stage infected total hip arthroplasty. J Arthroplasty. 2016;31:2574–2578
  • Flores X, Corona PS, Cortina J, et al. Temporary cement tectoplasty: a technique to improve prefabricated hip stability in two-stage surgery for infected hip arthroplasty. Arch Trauma Orthop Surg. 2012;132:719–724
  • Rogers BA, Kuchinad R, Garbedian S, et al. Cement augmentation of the acetabulum for revision total hip arthroplasty for infection. J Arthroplasty. 2015;30:270–271
  • Magill PJ, Donnelly MP Unpressurized cement acetabular liner (UCAL) – an additional technique for enhancing hip spacer performance. J Arthroplasty. 2014;29:638–639
  • Deshmukh RG, Thevarajan K, Kok CS, et al. An intramedullary cement spacer in total hip arthroplasty. J Arthroplasty. 1998;13:197–199
  • Incavo SJ, Russell RD, Mathis KB, et al. Initial results of managing severe bone loss in infected total joint arthroplasty using customized articulating spacers. J Arthroplasty. 2009;24:607–613.
  • Kamath AF, Anakwenze O, Lee GC, et al. Staged custom, intramedullary antibiotic spacers for severe segmental bone loss in infected total hip arthroplasty. Adv Orthop. 2011;2011:398954.
  • Richards C, Bell CJ, Viswanathan S, et al. Use of a cement-loaded Kuntscher nail in first-stage revision hip arthroplasty for massive femoral bone loss secondary to infection: report of four cases. J Orthop Surg (Hong Kong). 2010;18:107–109
  • Shields D, Kong R, Gupta S, et al. A novel antibiotic spacer for significant proximal femoral bone loss – surgical technique. Open Orthop J. 2017;11:508–516
  • Fink B, Oremek D The transfemoral approach for removal of well-fixed femoral stems in 2-stage septic hip revision. J Arthroplasty. 2016;31:1065–1071
  • Citak M, Gessmann J, Fehmer T, et al. Two-stage revision of infected total knee arthroplasty using a distraction spacer. Technol Health Care. 2011;19:167–171
  • Kotwal SY, Farid YR, Patill SS, et al. Intramedullary rod and cement static spacer construct in chronically infected total knee arthroplasty. J Arthroplasty. 2012;27:253–259
  • Nickinson RS, Board TN, Gambhir AK, et al. Two stage revision knee arthroplasty for infection with massive bone loss. A technique to achieve spacer stability. Knee. 2012;19:24–27.
  • Pfitzner T, Preininger B, Von Roth P, et al. A novel technique for stable intramedullary fixation of static spacers in two-stage septic revision TKA with severe bone defects. Z Orthop Unfall. 2015;153:203–205
  • Röhner E, Pfitzner T, Preininger B, et al. Temporary arthrodesis using fixator rods in two-stage revision of septic knee prosthesis with severe bone and tissue defects. Knee Surg Sports Traumatol Arthrosc. 2016;24:84–88
  • Schroder HM, Petersen MM Intramedullary knee spacer in 2-stage revision knee surgery with segmental bone loss: a technical note involving 6 cases. Acta Orthop. 2012;83:311–313
  • Yoo J, Lee S, Han C, et al. The modified static spacers using antibiotic-impregnated cement rod in two-stage revision for infected total knee arthroplasty. Clin Orthop Surg. 2011;3:245–248
  • Flores X, Vicente M, Haddad S, et al. “Reverse” hip spacer for massive distal femur defects in peri-prosthetic knee infections. Rev Esp Cir Ortop Traumatol. 2016;60:346–354
  • MacAvoy MC, Ries MD The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty. 2005;20:757–762
  • Macmull S, Bartlett W, Miles J, et al. Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability. Knee. 2010;17:403–406
  • Llado RJ, Banerjee S, Khanuja HS Smooth pins reinforcing static cement spacers for infected total knee arthroplasty are not safe. Orthopedics. 2016;39:e553–7
  • Amouyel T, Brunschweiler B, Freychet B, et al. No improvement in the post-TKA infection prognosis when the implant is not reimplanted: retrospective multicentre study of 72 cases. Orthop Traumatol Surg Res. 2015;101:S251–5
  • Choi HR, Freiberg AA, Malchau H, et al. The fate of unplanned retention of prosthetic articulating spacers for infected total hip and total knee arthroplasty. J Arthroplasty. 2014;29:690–693
  • Lee W, Hwang D, Kang C, et al. Usefulness of prosthesis made of antibiotic-loaded acrylic cement as an alternative implant in older patients with medical problems and periprosthetic hip infections: a 2- to 10-year follow-up study. J Arthroplasty. 2017;32:228–233
  • Mariconda M, Ascione T, Balato G, et al. Sonication of antibiotic-loaded cement spacers in a two-stage revision protocol for infected joint arthroplasty. BMC Musculoskelet Disord. 2013;14:193
  • Nelson CL, Jones RB, Wingert NC, et al. Sonication of antibiotic spacers predicts failure during zwo-stage revision for prosthetic knee and hip infections. Clin Orthop Relat Res. 2014;472:2208–2214.
  • Schmolders J, Hischebeth GT, Friedrich MJ, et al. Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee. BMC Infectious Dis. 2014;14:144
  • Sorli L, Puig R, Torres-Claramunt R, et al. 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: the use of sonication to aid bacteriological analysis. J Bone Joint Surg Br. 2012;94:249–253
  • Arciola CR, Campoccia D, Montanaro L Effects on antibiotic resistance of Staphylococcus epidermidis following adhesion to polymethylmethacrylate and to silicone surfaces. Biomaterials. 2002;23:1495–1502
  • Kendall RW, Duncan CP, Smith JA, et al. Persistence of bacteria on antibiotic loaded acrylic depots. Clin Orthop Relat Res. 1996;329:273–280
  • König DP, Schierholz JM, Hilgers RD, et al. In vitro adherence and accumulation of Staphylococcus epidermidis RP 62 A and Staphylococcus epidermidis M7 on four different bone cements. Langenbeck’s Arch Surg. 2001;386:328–332
  • Thomes 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
  • Anagnostakos K, Hitzler P, Pape D, et al. Persistence of bacterial growth on antibiotic-loaded beads: is it actually a problem? Acta Orthop. 2008;79:302–307
  • Neut D, Van De Belt H, Stokroos I, et al. Biomaterial-associated infection of gentamicin-loaded PMMA beads in orthopedic revision surgery. J Antimicrob Chemother. 2001;47:885–891
  • Griffin JW, Guillot SJ, Redick JA, et al. Removed antibiotic-impregnated spacers in two-stage revision joint arthroplasty do not show biofilm formation in vivo. J Arthroplasty. 2012;27:1796–1799
  • McDonald DJ, Fitzgerald RH Jr, Ilstrup DM Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am. 1989;71:828–834
  • Buttaro M, Valentini R, Piccaluga F Persistent infection associated with residual cement after resection arthroplasty of the hip. Acta Orthop Scand. 2004;75:427–429
  • Anagnostakos K, Kelm J, Regitz T, et al. In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers. J Biomed Mater Res Part B Appl Biomater. 2005;72:373–378
  • Klekamp J, Dawson JM, Haas DW, et al. The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics in joint arthroplasty. J Arthroplasty. 1999;14:339–346
  • Penner MJ, Masri BA, Duncan CP Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement. J Arthroplasty. 1996;11:939–944
  • Donlan RM New approaches for the characterization of prosthetic joint biofilms. Clin Orthop Relat Res. 2005;437:12–19
  • Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. New Engl J Med. 2007;357:654–663
  • Holinka J, Bauer L, Hirschl AM, et al. Sonication cultures of explanted components as an add-on-test to routinely conducted microbiological diagnostics improve pathogen detection. J Orthop Res. 2011;29:617–622

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