, Paul D. Siney1 and Patricia A. Fleming1
(1)
The John Charnley Research Institute Wrightington Hospital, Wigan, Lancashire, UK
When the infection rate was high, in the early years of this study, this cement was used only for the femoral prosthesis, but after 1961 the amount of cement doubled, being used for the socket as well, and despite this infection rates continued to fall.
Plain acrylic cement (CMW Laboratories now DePuy International, Blackpool, U.K.) was used in all cases. At one stage cement was suspected to be a contributory factor responsible for high infection rates. Because antibiotics were not included in the cement it was possible to establish the benefit of clean air enclosure, total body exhaust system and the instrument trays in reducing the infection rates. Use of cement was not the factor contributing to deep infection.
Antibiotic Containing Acrylic Cement
Buchholz and Colleagues [1] were the first to introduce antibiotic containing acrylic cement. Palacos/Gentamicin combination, was used both for prevention of deep infection in primary surgery and in one-stage revisions for deep infection. The release of Gentamicin was measured by its concentration in blood, urine, adjacent tissues and wound drainage fluid.
From various studies the conclusion was that Gentamicin does leach out from acrylic cement and that it is useful in reducing infection rate in primary procedures and also offering a high success rate in one-stage revisions for deep infection.
Comparison of Results Using Plain and Gentamicin Acrylic Cement [2]
Once the value of clean air enclosure, total body exhaust suits and the instrument tray system had been established, the next step was to examine the contribution that Gentamicin containing acrylic cement would make.
A retrospective review of 1542 Charnley LFAs was carried out. This was a single surgeon series. The operations were carried out during an 8 year period 1976–1983 and reviewed in 1987 to allow reasonable follow-up (Table 14.1).
Table 14.1
Comparison of results, with respect to deep infection, with plain CMW, and Gentamicin containing Palacos acrylic cement
CMW Plain | Palacos + Gentamicin | |||||
|---|---|---|---|---|---|---|
Number | Follow up (years) | Infection % | Number | Follow up (years) | Infection % | |
O.A. | 599 | 7.6 | 1.5 | 395 | 3.2 | 1.5 |
Rh. A. | 41 | 7.6 | 4.9 | 29 | 2.6 | 3.5 |
Previous surgery | 125 | 9.2 | 4.0 | 55 | 3.5 | 1.8 |
THA & hemi | 106 | 7.8 | 2.8 | 192 | 3.1 | 0.5
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