ObjectiveTo investigate the current problems and corresponding solutions regarding the use of antibiotic-impregnated cement spacer for the treatment of periprosthetic joint infection (PJI). MethodsA retrospective analysis was made on the clinical data of 27 patients with PJI who underwent two-stage revision with antibiotic-impregnated cement spacer between January 2001 and January 2013. There were 12 males and 15 females, with an average age of 62.7 years (range, 25-81 years). All arthroplasties were unilateral, including 19 hip PJI and 8 knee PJI. The mean duration from primary arthroplasty to PJI was 25 months (range, 3-252 months). After infection was controlled with the antibiotic-impregnated cement spacer combined with systematic antibiotics treatment, two-stage revision was performed. The effectiveness was evaluated. ResultsOne patient died of myocardial infarction at 2 days after surgery. Infection was controlled, and two-stage revision was successfully performed in 19 patients; deep venous thrombosis occurred in 1 of 3 patients who experienced hip spacer fractures, which was cured after conservative management. The spacers were removed and bacteria-sensitive antibiotics was used because of recurrent infections after the first-stage surgery in 7 patients; 3 patients gave up treatment because infection was not controlled, 4 patients received revision after infection was controlled. Twenty-three patients were followed up 1-5 years (mean, 2.3 years). The average Harris hip score and KSS score at 1 years after revision were significantly improved when compared with preoperative ones (P<0.05). In the 8 patients with gram-negative or fungus infection, 7 were found to have recurrent infection after the first-stage surgery; in the 12 patients with gram-positive infection, no recurrent infection was found. Failed treatment was observed in 1 patient with gram-positive and gram-negative infections and 2 with fungus infection, respectively. ConclusionAntibiotic-impregnated cement spacer has a satisfactory effectiveness for PJI. However, complication of spacer fracture should be noted, especially hip spacers. If the pathogen is gram-negative bacteria or fungus, the implanted spacer may increase the possibility of recurrent infection.
ObjectiveTo systematically review the correlation of diabetes mellitus (DM) with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA). MethodsStudies related to DM with PJI after TJA were collected from PubMed, EMbase and The Cochrane Library from inception to September 2021. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 13.0 software. ResultsA total of 26 studies involving 1 750 118 patients were included. The results of meta-analysis showed that the risk of PJI after TJA in DM patients was significantly higher than that in non-DM patients (OR=1.42, 95%CI 1.32 to 1.52, P<0.000 1). ConclusionCurrent evidence indicates a higher risk of PJI for DM patients than non-DM patients after TJA. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.