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<front>
<journal-meta>
<journal-id journal-id-type="publisher">JBJI</journal-id>
<journal-title-group>
<journal-title>Journal of Bone and Joint Infection</journal-title>
<abbrev-journal-title abbrev-type="publisher">JBJI</abbrev-journal-title>
<abbrev-journal-title abbrev-type="nlm-ta">J. Bone Joint Infect.</abbrev-journal-title>
</journal-title-group>
<issn pub-type="epub">2206-3552</issn>
<publisher><publisher-name>Ivyspring</publisher-name>
<publisher-loc>Göttingen, Germany</publisher-loc>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.7150/jbji.16067</article-id>
<title-group>
<article-title>Therapeutic Use of Antibiotic-loaded Bone Cement in the Treatment of Hip and Knee Joint Infections</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Anagnostakos</surname>
<given-names>Konstantinos</given-names>
</name>
<xref ref-type="aff" rid="aff1">
<sup>1</sup>
</xref>
</contrib>
</contrib-group><aff id="aff1">
<label>1</label>
<addr-line>Zentrum für Orthopädie und Unfallchirurgie, Klinikum Saarbrücken, Saarbrücken, Germany.</addr-line>
</aff>
<pub-date pub-type="epub">
<day>01</day>
<month>01</month>
<year>2017</year>
</pub-date>
<volume>2</volume>
<issue>1</issue>
<fpage>29</fpage>
<lpage>37</lpage>
<permissions>
<copyright-statement>Copyright: &#x000a9; 2017 Konstantinos Anagnostakos</copyright-statement>
<copyright-year>2017</copyright-year>
<license license-type="open-access">
<license-p>This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit <ext-link ext-link-type="uri"  xlink:href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</ext-link></license-p>
</license>
</permissions>
<self-uri xlink:href="https://jbji.copernicus.org/articles/2/29/2017/jbji-2-29-2017.html">This article is available from https://jbji.copernicus.org/articles/2/29/2017/jbji-2-29-2017.html</self-uri>
<self-uri xlink:href="https://jbji.copernicus.org/articles/2/29/2017/jbji-2-29-2017.pdf">The full text article is available as a PDF file from https://jbji.copernicus.org/articles/2/29/2017/jbji-2-29-2017.pdf</self-uri>
<abstract>
<p>&lt;p class=&quot;p p-first-last&quot; id=&quot;__p2&quot;&gt;The use of antibiotic-loaded cement spacers is an established method in the management of periprosthetic hip and knee joint infections. Despite inconsistencies among published studies, data shows that infection control rates exceed 90% with two-stage exchange arthroplasty. The present work reviews the current literature about antibiotic-loaded cement spacers and concentrates on the indications for spacer implantation, spacer production details, antibiotic impregnation, pharmacokinetic properties, clinical success, mechanical complications, and systemic safety.&lt;/p&gt;</p>
</abstract>
<counts><page-count count="9"/></counts>
</article-meta>
</front>
<body/>
<back>
<ref-list>
<title>References</title>
<ref id="ref0">
<label>0</label><mixed-citation publication-type="other" xlink:type="simple">Anagnostakos K, Kelm J. Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater. 2009;90:467–75.</mixed-citation>
</ref>
<ref id="ref1">
<label>1</label><mixed-citation publication-type="other" xlink:type="simple">Anagnostakos K, Fürst O, Kelm J. Antibiotic-impregnated PMMA hip spacers: current status. Acta Orthop. 2006;77:628–37.</mixed-citation>
</ref>
<ref id="ref2">
<label>2</label><mixed-citation publication-type="other" xlink:type="simple">Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. 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.</mixed-citation>
</ref>
<ref id="ref3">
<label>3</label><mixed-citation publication-type="other" xlink:type="simple">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;29:558–63.</mixed-citation>
</ref>
<ref id="ref4">
<label>4</label><mixed-citation publication-type="other" xlink:type="simple">Kuzyk PR, Dhotar HS, Sternheim A, Gross AE, Safir O, Backstein D. Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes. J Am Acad Orthop Surg. 2014;22:153–64.</mixed-citation>
</ref>
<ref id="ref5">
<label>5</label><mixed-citation publication-type="other" xlink:type="simple">Pivec R, Naziri Q, Issa K, Banerjee S, Mont MA. Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J Arthroplasty. 2014;29:553–7.</mixed-citation>
</ref>
<ref id="ref6">
<label>6</label><mixed-citation publication-type="other" xlink:type="simple">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;95:1594–9.</mixed-citation>
</ref>
<ref id="ref7">
<label>7</label><mixed-citation publication-type="other" xlink:type="simple">Masri BA, Duncan CP, Beauchamp CP. Long-term elution of antibiotics from bone-cement. J Arthroplasty. 1998;13:331–8.</mixed-citation>
</ref>
<ref id="ref8">
<label>8</label><mixed-citation publication-type="other" xlink:type="simple">Masri BA, Duncan CP, Beauchamp CP, Paris NJ, Arntorp J. Tobramycin and Vancomycin elution from bone cement. An in vivo and in vitro study. Orthop Trans. 1994;18:130. [Google Scholar]</mixed-citation>
</ref>
<ref id="ref9">
<label>9</label><mixed-citation publication-type="other" xlink:type="simple">Isiklar ZU, Demirörs H, Akpinar S, Tandogan RN, Alparslan M. Two-stage treatment of chronic staphylococcal implant-related infections using Vancomycin- impregnated PMMA-Spacer and rifampicin containing antibiotic protocol. Bull Hosp Jt Dis. 1999;58:79–85.</mixed-citation>
</ref>
<ref id="ref10">
<label>10</label><mixed-citation publication-type="other" xlink:type="simple">Hsieh PH, Chang YH, Chen SH, Ueng SW, Shih CH. 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;24:1615–21.</mixed-citation>
</ref>
<ref id="ref11">
<label>11</label><mixed-citation publication-type="other" xlink:type="simple">Anagnostakos K, Wilmes P, Schmitt E, Kelm J. Elution of gentamicin and vancomycin from polymethylmethacrylate beads and hip spacers in vivo. Acta Orthop. 2009;80:193–7. [PMC free article]</mixed-citation>
</ref>
<ref id="ref12">
<label>12</label><mixed-citation publication-type="other" xlink:type="simple">Fink B, Vogt S, Reinsch M, Büchner H. Sufficient release of antibiotic by a spacer 6 weeks after implantation in two-stage revision of infected hip prostheses. Clin Orthop Relat Res. 2011;469:3141–7. [PMC free article]</mixed-citation>
</ref>
<ref id="ref13">
<label>13</label><mixed-citation publication-type="other" xlink:type="simple">Mutimer J, Gillespie G, Lovering AM, Porteous AJ. Measurement of in vivo intra-articular gentamicin levels from antibiotic loaded articulating spacers in revision total knee replacement. Knee. 2009;16:39–41.</mixed-citation>
</ref>
<ref id="ref14">
<label>14</label><mixed-citation publication-type="other" xlink:type="simple">Bertazzonnni Minelli E, Benini A, Magnan B, Bartolozzi P. Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. J Antimicrob Chemother. 2004;53:329–34.</mixed-citation>
</ref>
<ref id="ref15">
<label>15</label><mixed-citation publication-type="other" xlink:type="simple">Kelm J, Regitz T, Schmitt E, Jung W, Anagnostakos K. In vivo and in vitro studies of antibiotic release from and bacteria growth inhibition by antibiotic-impregnated polymethylmethacrylate hip spacers. Antimicrob Agents Chemother. 2006;50:332–5. [PMC free article]</mixed-citation>
</ref>
<ref id="ref16">
<label>16</label><mixed-citation publication-type="other" xlink:type="simple">McDonald DJ, Fitzgerald RH Jr, Ilstrup DM. Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am. 1989;71:828–34.</mixed-citation>
</ref>
<ref id="ref17">
<label>17</label><mixed-citation publication-type="other" xlink:type="simple">Buttaro M, Valentini R, Piccaluga F. Persistent infection associated with residual cement after resection arthroplasty of the hip. Acta Orthop Scand. 2004;75:427–9.</mixed-citation>
</ref>
<ref id="ref18">
<label>18</label><mixed-citation publication-type="other" xlink:type="simple">Leunig M, Chosa E, Speck M, Ganz R. A cement spacer for two-stage revision of infected implants of the hip-joint. Int Orthop. 1998;22:209–14. [PMC free article]</mixed-citation>
</ref>
<ref id="ref19">
<label>19</label><mixed-citation publication-type="other" xlink:type="simple">Anagnostakos K, Köhler D, Schmitt E, Kelm J. The “glove”-technique: a modified method for femoral fixation of antibiotic-loaded hip spacers. Acta Orthop. 2009;80:386–8. [PMC free article]</mixed-citation>
</ref>
<ref id="ref20">
<label>20</label><mixed-citation publication-type="other" xlink:type="simple">Magnan B, Regis D, Biscaglia R, Bartolozzi P. Preformed acrylic bone cement spacer loaded with antibiotics. Use of two-stage procedure in 10 patients because of infected hips after total replacement. Acta Orthop Scand. 2001;72:591–4.</mixed-citation>
</ref>
<ref id="ref21">
<label>21</label><mixed-citation publication-type="other" xlink:type="simple">Duncan CP, Beauchamp C. A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am. 1993;24:751–9.</mixed-citation>
</ref>
<ref id="ref22">
<label>22</label><mixed-citation publication-type="other" xlink:type="simple">Ries MD, Jergesen H. An inexpensive molding method for antibiotic- impregnated cement spacers in infected total hip arthroplasty. J Arthroplasty. 1999;14:764–5.</mixed-citation>
</ref>
<ref id="ref23">
<label>23</label><mixed-citation publication-type="other" xlink:type="simple">Koo KH, Yang JW, Cho SH, Song HR, Park HB, Ha YC, Chang JD, Kim SY, Kim YH. Impregnation of vancomycin, gentamicin and cefotaxime in a cement spacer for two-stage cementless reconstruction in infected total hip arthroplasty. J Arthroplasty. 2001;16:882–92.</mixed-citation>
</ref>
<ref id="ref24">
<label>24</label><mixed-citation publication-type="other" xlink:type="simple">Shin SS, Della Valle CJ, Ong BC, Meere PA. A simple method for construction of an articulating antibiotic-loaded cement spacer. J Arthroplasty. 2002;17:785–7.</mixed-citation>
</ref>
<ref id="ref25">
<label>25</label><mixed-citation publication-type="other" xlink:type="simple">Takahira N, Itoman M, Higashi K, Utsiyama K, Miyabe M, Naruse K. Treatment outcome of two-stage revision total hip arthroplasty for infected hip arthroplasty using antibiotic-impregnated cement spacer. J Orthopedic Sci. 2003;8:26–31.</mixed-citation>
</ref>
<ref id="ref26">
<label>26</label><mixed-citation publication-type="other" xlink:type="simple">Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265–73. [PMC free article]</mixed-citation>
</ref>
<ref id="ref27">
<label>27</label><mixed-citation publication-type="other" xlink:type="simple">Struelens B, Claes S, Bellemans J. Spacer-related problems in two-stage revision knee arthroplasty. Acta Orthop Belg. 2013;79:422–6.</mixed-citation>
</ref>
<ref id="ref28">
<label>28</label><mixed-citation publication-type="other" xlink:type="simple">Faschingbauer M, Bieger R, Reichel H, Weiner C, Kappe T. Complications associated with 133 statuic, antibiotic-laden spacer after TKA. Knee Surg Sports Traumatol Arthrosc. 2015 [epub ahead of print]</mixed-citation>
</ref>
<ref id="ref29">
<label>29</label><mixed-citation publication-type="other" xlink:type="simple">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;38:405–12. [PMC free article]</mixed-citation>
</ref>
<ref id="ref30">
<label>30</label><mixed-citation publication-type="other" xlink:type="simple">Kim YS, Bae KC, Cho CH, Lee KJ, Sohn ES, Kim BS. Two-stage revision using a modified articulating spacer in infected total knee arthroplasty. Knee Surg Relat Res. 2013;25:180–5. [PMC free article]</mixed-citation>
</ref>
<ref id="ref31">
<label>31</label><mixed-citation publication-type="other" xlink:type="simple">Van Thiel GS, Berend KR, Klein GR, Gordon AC, Lombardi AV, Della Valle CJ. Intraoperative molds to create an articulating spacer for the infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:994–1001. [PMC free article]</mixed-citation>
</ref>
<ref id="ref32">
<label>32</label><mixed-citation publication-type="other" xlink:type="simple">Johnson AJ, Sayeed SA, Naziri Q, Khanuja HS, Mont MA. Minimizing dynamic knee spacer complications in infected revision arthroplasty. Clin Orthop Relat Res. 2012;470:220–7. [PMC free article]</mixed-citation>
</ref>
<ref id="ref33">
<label>33</label><mixed-citation publication-type="other" xlink:type="simple">Salvati EA, Callaghan JJ, Brause BD, Klein RF, Small RD. Reimplantation in infection: elution of gentamicin from cement and beads. Clin Orthop. 1986;207:83–93.</mixed-citation>
</ref>
<ref id="ref34">
<label>34</label><mixed-citation publication-type="other" xlink:type="simple">Springer BD, Lee GC, Osmon D, Haidukewych GJ, Hanssen AD, Jacofsky DJ. 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.</mixed-citation>
</ref>
<ref id="ref35">
<label>35</label><mixed-citation publication-type="other" xlink:type="simple">Van Raaij TM, Visser LE, Vulto AG, Verhaar JA. Acute local failure after local gentamicin treatment of an infected total knee arthroplasty. J Arthroplasty. 2002;17:948–50.</mixed-citation>
</ref>
<ref id="ref36">
<label>36</label><mixed-citation publication-type="other" xlink:type="simple">Patrick BN, Rivey MP, Allington DR. Acute renal failure associated with vancomycin- and tobramycin-laden cement in total hip arthroplasty. Ann Pharmacother. 2006;40:2037–42.</mixed-citation>
</ref>
<ref id="ref37">
<label>37</label><mixed-citation publication-type="other" xlink:type="simple">Curtis JM, Sternhagen V, Batts D. Acute renal failure after placement of tobramycin-impregnated bone cement in an infected total knee arthroplasty. Pharmacotherapy. 2005;25:876–80.</mixed-citation>
</ref>
<ref id="ref38">
<label>38</label><mixed-citation publication-type="other" xlink:type="simple">Dovas S, Liakopoulos V, Papatheodorou L, Chronopoulou I, Papavasiliou V, Atmatzidis E, Giannopoulou M, Eleftheriadis T, Simopoulou T, Karachalios T, Stefanidis I. Acute renal failure after antibiotic-impregnated bone cement treatment of an infected total knee arthroplasty. Clin Nephrol. 2008;69:207–12.</mixed-citation>
</ref>
<ref id="ref39">
<label>39</label><mixed-citation publication-type="other" xlink:type="simple">Cabrita HB, Croci AT, Camargo OP, Lima AL. Prospective study of the treatment of infected hip arthroplasties with or without the use of an antibiotic-loaded cement spacer. Clinics. 2007;62:99–108.</mixed-citation>
</ref>
<ref id="ref40">
<label>40</label><mixed-citation publication-type="other" xlink:type="simple">Wentworth SJ, Masri BA, Duncan CP, Southworth CB. Hip prosthesis of antibiotic-loaded acrylic cement for the treatment of infections following total hip arthroplasty. J Bone Joint Surg (Am) 2003;84:123–8.</mixed-citation>
</ref>
<ref id="ref41">
<label>41</label><mixed-citation publication-type="other" xlink:type="simple">Scharfenberger A, Clark M, Lavoie G, O&apos;Connor G, Masson E, Beaupre LA. Treatment of an infected total hip replacement with the PROSTALAC system. Part 1: infection resolution. Can J Surg. 2007;50:24–8. [PMC free article]</mixed-citation>
</ref>
<ref id="ref42">
<label>42</label><mixed-citation publication-type="other" xlink:type="simple">Fink B, Rechtenbach A, Büchner H, Vogt S, Hahn M. Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time. Clin Orthop Relat Res. 2011;469:1095–1102. [PMC free article]</mixed-citation>
</ref>
<ref id="ref43">
<label>43</label><mixed-citation publication-type="other" xlink:type="simple">Hoberg M, Konrads C, Engelien J, Oschmann D, Holder M, Walcher M, Steinert A, Rudert M. Similar outcomes between two-stage revisions for infection and aseptic hip revisions. Int Orthop. 2016;40:459–64.</mixed-citation>
</ref>
</ref-list>
</back>
</article>