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Authors Mutimer J, Gillespie G, Lovering AM, Porteous AJ |
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Institute Trauma and Orthopaedics, Southmead Hospital, Bristol, United Kingdom. |
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Journal Knee. 2009 Jan;16(1):39-41. |
Take Home message:
- Preformed spacers guarantee therapeutic concentrations of antibiotic in synovial fluid surrounding the joint throughout the period of implantation
- The key is the antibiotic release performance, not the antibiotic dose
| Study details | Score | Range | |
|---|---|---|---|
| Subject | Clinical | - | - |
| Type | Retrospective study | 1 | 1-3 |
| Journal | The Knee | 2 | 1-3 |
A high concentration of gentamicin was found in synovial liquid of 12 patients which received Spacer-K on the day of spacer removal.
Patients characteristics
12 patients (6 M, 6 F) with a mean age of 71 years
Pathogens: Coagulase-negative Staphyococcus (10), Stapylococcus aureus (2)
Treatment
Spacer-K was fixed with gentamicin-loaded cement. Drains removed after 24h. A 14-day regime of parenteral ABX followed by a further 4 weeks of oral ABX.
No patients received further administration of gentamicin.
Median spacer implantation (range)
99 days (63 – 274)
Two implants were left in situ more due to patients comorbidities
Mean FU
10 months
Infection eradication
100% (12/12 patients)
Gentamicin concentration in synovial fluid
From 0,24 to 2,36 mg/L (0,46 mg/L)
Gentamicin concentration in blood samples
Very low or below the limit of detection
Key points:
- Therapeutic concentration (0,46 mg/L) of Gentamicin in synovial fluid around the joint after 99 days of spacer implantation
- Low concentration of Gentamicin (0,06 mg/L) in blood: no toxicity (recommended max daily dose limit 5 mg/Kg/day)
- Antibiotic release from preformed spacers depends on polymer matrix, and not on the antibiotic dose
| Study value | Description |
| * | Retrospective study |
| * * |
Retrospective comparative Retrospective Register study |
| * * * |
Prospective study Systematic review Meta-analysis |
| Journal value | Description |
| * | Low impact factor (1.500) |
| * * | Medium impact factor (1.500-2.500) |
| * * * | High impact factor (>2.500) |