Abstract
Polymethylmethacrylate (PMMA) has been used in skeletal surgery for >40 years as a
means of securing prosthetic implants and more recently was used as a delivery agent
for local high-dose antibiotics to treat soft tissue and osseous infections. The purpose
of this study was to determine the role of PMMA antibiotic-loaded cement (PMMA-ALC)
in combination with aggressive debridement for the treatment of foot and ankle soft
tissue and osseous infections requiring operative intervention. A retrospective observational
cohort study of prospectively collected data was performed for all patients who underwent
aggressive debridement with placement of PMMA-ALC for foot and ankle soft tissue and
osseous infections between July 2006 and January 2009. There were 35 (29 men, 6 women)
patients, 29 who had diabetes, with a mean age of 61 1 13 years (range, 16-86 years).
A total of 36 feet/ankles (20 right, 16 left) were involved, and the infections were
anatomically divided into 6 groups: (1) toes (n = 9), (2) metatarsalphalangeal joints
(MTPJ) (first MTPJ, n = 5; fifth MTPJ, n = 5), (3) forefoot (n = 11), (4) rearfoot
(n = 4), and (6) ankle/lower leg (n = 3). All patients had confirmed bacterial infection
via microbiologic or pathologic analysis before PMMA-ALC insertion. A total of 73
cultures were obtained at the time of PMMA-ALC removal, with 66 showing no bacterial
growth (90.4%) and 7 positive for bacterial growth (9.6%). Methicillin-resistant Staphylococcus
aureus was the most commonly cultured organism both preoperatively and postoperatively.
When combined with aggressive irrigation and debridement, the use of PMMA-ALC appears
to be a beneficial adjunctive therapy for the treatment of foot and ankle soft tissue
and osseous infections.
Level of Evidence
Keywords
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References
- A new operation for arthroplasty of the hip based on biomechanics, photoelasticity, fast-setting dental acrylic, and other considerations.Bull Hosp Jt Dis. 1953; 14: 242-277
- Surgery of the hip-joint: present and future developments.Br Med J. 1960; 19: 821-826
- Anchorage of the femoral head prosthesis to the shaft of the femur.J Bone Joint Surg Br. 1960; 42: 28-30
- Results of cemented metal-backed acetabular components: a 10-year-average follow-up study.J Arthroplasty. 1998; 13: 867-873
- The role of polymethylmethacrylate bone cement in modern orthopaedic surgery.J Bone Joint Surg Br. 2007; 89: 851-857
- Depot effects of various antibiotics mixed with Palacos resins.Chirurg. 1970; 41: 511-515
- Gentamicin-PMMA-beads in treating bone and soft tissue infections.Zentralbl Chir. 1979; 104: 934-942
- The treatment of infected osteosynthesis using gentamicin - PMMA - bead chains.Hefte Unfallheilkd. 1979; 138: 197-200
- Gentamicin-PMMA-spheres in bone and soft tissue infections-results from the occupational co-operative accident hospital Frankfurt/Main.Aktuelle Probl Chir Orthop. 1979; 12: 128-132
- Indication for and technic of gentamicin-PMMA-spheres insertion in bone and soft tissue defects.Aktuelle Probl Chir Orthop. 1979; 12: 121-127
- The use of antibiotic-containing bead chains in the treatment of chronic bone infections.Clin Microbiol Infect. 2001; 7: 28-31
- The use of gentamicin-PMMA chains in the treatment of infected tibial nonunion.Acta Orthop Belg. 1992; 58: 222-226
- Local treatment of infection with gentamicin-PMMA chains and minichains.Aktuelle Probl Chir Orthop. 1990; 34: 65-77
- Treatment of chronic osteomyelitis with gentamicin PMMA chains.Unfallchirurgie. 1986; 12: 128-131
- Antibiotic bead chains.Clin Orthop Relat Res. 1993; 295: 63-76
- Gentamicin-PMMA chains (Septopal® chains) for the local antibiotic treatment of chronic osteomyelitis.Reconstr Surg Traumatol. 1998; 20: 11-35
van Rens JG, Kayser FH. Local antibiotic treatment in osteomyelitis and soft-tissue infections. Proceedings of a Symposium, Amsterdam, 25 October 1980. Excerpta Medica. Amsterdam, The Netherlands, 1981.
- Local antibiotic delivery vehicles in the treatment of musculoskeletal infection.Clin Orthop Relat Res. 2005; 437: 91-96
- Implanted gentamicin beads in the treatment of osteomyelitis. A case report.J Am Podiatr Med Assoc. 1987; 77: 563-566
- Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement.J Bone Joint Surg Am. 2006; 88: 2487-2500
- The treatment of infected nonunions with gentamicin-polymethylmethacrylate antibiotic beads.Clin Orthop Relat Res. 1993; 295: 23-27
- Antibiotic beads in the management of surgical infections.Am J Surg. 1989; 157: 443-449
- Antibiotic-impregnated cement beads for orthopedic infections.Antimicrob Agents Chemother. 1996; 40: 2675-2679
- Volume and surface area study of Tobramycin-polymethylmethacrylate beads.Clin Orthop Relat Res. 2004; 420: 298-303
- Local antibiotic therapy in the treatment of open fractures and osteomyelitis.Clin Orthop Relat Res. 2004; 427: 86-93
- A characterization of polymethylmethacrylate bone cement.J Bone Joint Surg Am. 1975; 57: 380-391
- Treatment of the infected extended ankle arthrodesis after tibiotalocalcaneal retrograde nailing.Tech Foot Ankle Surg. 2002; 1: 74-86
- The application of bioimplants in the management of chronic osteomyelitis.Orthopedics. 2002; 25: 1247-1252
- Use of antibiotic-loaded bone cement in the management of common infections of the foot and ankle.Clin Pod Med Surg. 1990; 7: 523-544
- Antibiotic-impregnated beads, part II: factors in antibiotic selection.Orthop Rev. 1991; 20: 331-337
- Antibiotic beads in the treatment of diabetic pedal osteomyelitis.J Foot Ankle Surg. 2000; 39: 124-130
- Antibiotic-impregnated cement in total joint arthroplasty.J Bone Joint Surg Am. 1986; 68: 1297-1302
- Antibiotics and bone cements: experimental and clinical long-term observation.Acta Orthop Scand. 1980; 51: 49-56
- Antibiotic-leaching from polymethylmethacrylate beads.J Bone Joint Surg Am. 1993; 75: 714-720
- Incorporation of large amounts of Gentamicin sulphate into acrylic bone cement: effect on handling and mechanical properties, antibiotic release, and biofilm formation.Proc Inst Mech Eng [H]. 2008; 222: 355-365
- Does antibiotic elution from PMMA beads deteriorate after 1-year shelf storage?.Clin Orthop Relat Res. 2007; 462: 195-199
- Antibiotic-impregnated cement spacer for bone defects of the forearm and hand.Tech Hand Up Extrem Surg. 2007; 11: 163-167
- The antibiotic bead pouch technique in the management of severe compound fractures.Clin Orthop Relat Res. 1993; 295: 54-62
- The prophylactic use of antibiotic impregnated beads in open fractures.J Trauma. 1990; 30: 1231-1283
- The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.J Ortho Trauma. 1992; 6: 401-406
- Antibiotic-impregnated beads in orthopedic infectious problems.J Ky Med Assoc. 1984; 82: 25-29
- Septopal beads and autogenous bone grafting for bone defects in patients with chronic osteomyelitis.Clin Orthop Relat Res. 1993; 295: 112-118
- The effect of mixing on gentamicin release from polymethylmethacrylate bone cements.Acta Orthop Scand. 2003; 74: 670-676
- Orthopedic infections: use of antibiotic-PMMA beads in the ischemic foot.Orthopedics. 1994; 17: 453-457
- Antibiotic-impregnated beads, part I: bead implantation versus systemic therapy.Ortho Rev. 1991; 20: 242-247
- Orthopedic infections: elution characteristics of gentamicin-PMMA beads after implantation in humans.Orthopedics. 1994; 17: 415-416
- Long-term implantation of gentamicin-polymethylmethacrylate antibiotic beads.Clin Orthop Relat Res. 1993; 295: 47-53
- Gentamicin-PMMA beads in the treatment of chronic osteomyelitis.Acta Orthop Scand. 1985; 56: 265-268
- Use of antibiotic-loaded polymethyl methacrylate beads in the management of musculoskeletal sepsis: a retrospective study.J Ortho Surg. 2003; 11: 73-79
- The use of gentamicin PMMA (Septopal®) in the treatment of chronic bone sepsis.J Bone Joint Surg Br. 1980; 62: 275
- Treatment of chronic osteomyelitis by necrectomy and gentamicin-PMMA Beads.Clin Orthop Relat Res. 1981; 159: 201-207
- Local antibiotic therapy for severe open fractures: a review of 1,085 consecutive cases.J Bone Joint Surg Br. 1995; 77: 93-97
- The role of local antibiotic therapy in the management of compound fractures.Clin Orthop Relat Res. 1993; 295: 102-111
- Wound and serum levels of Tobramycin with the prophylactic use of Tobramycin-impregnated polymethylmethacrylate beads in compound fractures.Clin Orthop Relat Res. 1988; 237: 213-215
- Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined with systemic therapy for osteomyelitis.Clin Orthop Relat Res. 1993; 295: 8-12
- The use of Septopal (polymethymethacrylate beads with gentamicin) in the treatment of chronic osteomyelitis.Instr Course Lect. 1990; 39: 509-514
- Audiometric thresholds in osteomyelitis patients treated with gentamicin-impregnated methylmethacrylate beads (Septopal®).Clin Orthop Relat Res. 1993; 295: 43-46
- The Ilizarov fixator and polymethylmethacrylate-antibiotic beads for the treatment of infected deformities.Clin Orthop Relat Res. 1993; 295: 13-22
- Antibiotic-impregnated cement beads in the treatment of chronic osteomyelitis.Hosp J Dis. 1997; 56: 140-144
- Results of Septopal™ in more than 1500 cases of bone and soft-tissue infections: a review of the clinical trial.J Bone Joint Surg Br. 1980; 62: 275
- Antibiotic containing bone cement beads in the treatment of deep muscle and skeletal infections.Acta Orthop Scand. 1980; 51: 863-869
- The treatment of bone infection with PMMA beads compared with local antibiotic instillation.J Bone Joint Surg Br. 1980; 62: 275-276
Article info
Footnotes
Disclaimer: The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of the Army or the Department of Defense.
Financial Disclosure: None reported.
Conflict of Interest: None reported.
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© 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
