Adding a glycopeptide to the cement spacer in 2-stage exchange procedures for periprosthetic joint infections reduces the rate of positive cultures during re-implantation and is associated with a lower failure rate due to coagulase-negative staphylococci, according to research results published in Clinical Infectious Diseases.

A multicenter study retrospectively examined 2-stage exchange procedures performed from 2000 to 2015 at 2 academic centers in order to define the role of antibiotics in the cement space with regard to re-implantation cultures and subsequent failure.

Patients in whom no cultures were obtained, patients without data on cement spacers, and patients with culture-negative periprosthetic joint infections were excluded from the study, leaving 344 patients cases to be analyzed.

Continue Reading

The rate of positive cultures during re-implantation for cement spacers containing a glycopeptide compared to those containing monotherapy with an aminoglycoside was 9.5% vs 21.7%; respectively (P =.008). The difference was attributed to reductions in coagulase-negative staphylococci, which were 17% in patients receiving glycopeptide treated spacers vs 2% in patients receiving monotherapy (P <.001). In patients with positive cultures at re-implantation the failure rate was greater than 2-fold higher: 40% compared to 15.8% when cultures were negative (P <.001). A gylcopeptide in the cement spacer was associated with a lower failure rate due to coagulase-negative staphylococci: 2.5% with glycopeptide vs 13.3% without (P <.001). This, however, was not the case for the overall failure rate with cement spacers with or without a glycopeptide, which was 18% vs 23%, respectively (P =.3).

The data reported here may suffer from selection bias due to the retrospective nature of the study, which complicates interpretation. Further, variation between the 2 centers and small changes over time to culturing techniques and prophylactic regimens meant the exact influence of these on positive cultures during re-implantation could not be evaluated. In addition, detailed information on factors such as previous surgeries, quality of bone-stock, and antibiotic treatment was not collected and these may have contributed to or served as further risk factors for poor outcomes.

Related Articles

The investigators concluded that high infection rates during 2-stage exchange procedures both during re-implantation and follow-up require improved treatment strategies. They also stated that routinely adding a glycopeptide to the cement spacer can achieve a reduction in positive cultures, which in turn may also reduce failure rates due to coagulase-negative staphylococci.  


Wouthuyzen-Bakker M, Kheir MM, Moya I, et al. Failure after two-stage exchange arthroplasty for treatment of periprosthetic joint infection: the role of antibiotics in the cement spacer [published online October 3 2018]. Clin Infect Dis. doi:10.1093/cid/ciy851