Periprosthetic Infections in Orthopaedic Oncology Treated with High Dose Vancomycin Cement Spacers- Safety and Efficacy

Purpose: The goal of this study was to assess the safety and effectiveness of high dose vancomycin in cement spacers.

Methods: Thirteen patients with a history of cancer who underwent surgery presented with a periprosthetic infection. Infection was located in the femur in nine and the tibia in four. The knee joint was involved in seven, the shaft in 5 and the hip in one. A part of the prosthesis was retained in three patients and all the infected hardware was removed in 10 patients. A metal implant was included with the spacer in 12 patients. More than 4 grams of vancomycin was used in all cases.

Results: None of the patients suffered from Vancomycin related complications such as nephrotoxicity, ototoxicity, CNS or hematologic complications. CRP declined in all patients and remained low even in the antibiotic window. None of the patients had a recurrence of the infection. Eight patients underwent a second stage revision with a new prosthesis. Five are infection free without antibiotics and still have their spacer construct.

Conclusion: Even in the oncologic setting with megaprothesis after radiation and chemotherapy eradicating infection is still possible. High dose Vancomycin spacers are safe and effective.