Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty.

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Abstract

[Indexed for MEDLINE] 15. Antibiotics (Basel). 2024 Aug 15;13(8):772. doi: 10.3390/antibiotics13080772. Antimicrobial Regimens in Cement Spacers for Periprosthetic Joint Infections: A Critical Review. Naoum S(1), Koutserimpas C(2)(3), Pantekidis I(4), Giovanoulis V(5), Veizi E(6), Piagkou M(3), Ioannou P(7), Samonis G(7)(8), Domouchtsidou A(9), Tsantes AG(9)(10), Papadopoulos DV(11). Author information: (1)Department of Trauma and Orthopaedics, Royal Berkshire Hospital, Reading RG1 5AN, UK. (2)Orthopaedic Surgery and Sports Medicine Department, Croix-Rousse Hospital, University Hospital, 69317 Lyon, France. (3)Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, 75 Mikras Asias Str., Goudi, 11527 Athens, Greece. (4)Department of Trauma and Orthopaedics, Guy's and St. Thomas' NHS Foundation Trust, London SE1 7EH, UK. (5)Department of Orthopaedic Surgery, Hôpital Henri Mondor, AP-HP, Université Paris Est Créteil (UPEC), 94010 Creteil, France. (6)Department of Orthopedics and Traumatology, Yıldırım Beyazıt University, Ankara City Hospital, Ankara 2367, Turkey. (7)School of Medicine, University of Crete, 71003 Heraklion, Greece. (8)First Department of Medical Oncology, Metropolitan Hospital of Neon Faliron, 18547 Athens, Greece. (9)Microbiology Department, "Saint Savvas" Oncology Hospital, 11522 Athens, Greece. (10)Laboratory of Hematology and Blood Bank Unit, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece. (11)2nd Academic Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 14233 Athens, Greece. Antibiotic-loaded cement spacers (ALCSs) are essential for treating periprosthetic joint infections (PJIs) by providing mechanical support and local antibiotic delivery. The purpose of this review is to comprehensively examine the various types of spacers utilised in the management of periprosthetic joint infections (PJIs), including both static and articulating variants and to analyse the fundamental principles underlying spacer use, their clinical benefits, the selection and administration of antimicrobial agents, appropriate dosages, and potential adverse effects. Articulating spacers, which allow joint mobility, often yield better outcomes than static ones. Spacer pharmacokinetics are vital for maintaining therapeutic antibiotic levels, influenced by cement porosity, mixing techniques, and the contact area. Antibiotic choice depends on heat stability, solubility, and impact on cement's mechanical properties. Mechanical properties are crucial, as spacers must withstand physical stresses, with antibiotics potentially affecting these properties. Complications, such as tissue damage and systemic toxicity, are discussed, along with mitigation strategies. Future advancements include surface modifications and novel carriers to enhance biofilm management and infection control. DOI: 10.3390/antibiotics13080772 PMCID: PMC11351621