[Addition of antibiotics to bone cement for septic prosthesis exchange].

OBJECTIVE: Decontamination of periprosthetic infections by local antibiotic therapy with maximum dosing. Commercially available bone cement is used as the carrier material. Bone cement containing antibiotics is an established procedure in orthopedics for the fixation of cemented implants in artificial joint replacement. It is part of the primary and revision endoprosthetic treatment together with systemic administration of antibiotics for routine local antibiotic prophylaxis. INDICATIONS: Bone cement containing antibiotics is used in the treatment of periprosthetic infections for two-stage septic exchange operations as a spacer in the prosthesis-free interval and for reimplantation in the second operation. In one-stage septic exchange operations it is an essential means of achieving a locally sufficient antibiotic concentration, which allows direct reimplantation following radical débridement of the infected tissue. The high antibiotic concentration prevents recolonization and formation of a biofilm on the surface of the new implant. CONTRAINDICATIONS: Periprosthetic infections with pathogens which are known to be resistant to the antibiotics used in the mixture. Unsuitability of patients for surgery under anesthesia. Known allergies of patients to substances mixed with or contained in the cement. OPERATION TECHNIQUE: Homogenization of the powdered antibiotic. Mixing of the antibiotic with the powder phase of the bone cement. Homogenization of the antibiotic-cement mixture by stirring. Addition of the liquid monomer and the usual mixing procedure. Application of the cement in the routine manner.