Outcome of early control of infection using antibiotics impregnated cement beads in early surgical site infection in operated case of intra articular comminuted fracture (AO C3) of distal femur with ORIF: case report and review of literature

Kunal Chaudhari, Neetin P. Mahajan, Sunny Sangma, Ashish Kumar Jarika, Pritam Talukderg


Surgical site infection is the most deleterious complication for any surgery and it's quite a daunting task for the surgeon to manage such post op events which also takes a great toll on patients' health physically as well as financially. Here we are presenting one such case report of early SSI effectively managed with antibiotic cement beads incorporation locally. We report a 65 year old male patient case of left sided comminuted distal femur fracture who was managed operatively with open reduction and internal fixation with 8 holes distal femur plate. Patient developed early SSI and was managed with debridement and antibiotic cement beads which was removed 6 weeks later. Here, we bring to the fore relevant findings to conclude the advantages of antibiotic cement beads for infected surgical wounds. In our case, early intervention resulted in full recovery of the patient from surgical site infection, early rehabilitation of joint mobility, decreased hospital stay and expenses. Looking at the advantages it is concluded from our study that locally impregnated antibiotic beads confers higher effectivity, compliance and cost benefits to the patient.  


Surgical site infection, Antibiotic beads, Systemic toxicity, Debridement

Full Text:



Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. The Journal of arthroplasty. 2012;27(8):61-5.

Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control HospEpidemiol. 2002;23(4):183-9.

Korol E, Johnston K, Waser N, Sifakis F, Jafri HS, Lo M, Kyaw MH. A systematic review of risk factors associated with surgical site infections among surgical patients. PLoS One. 2013;8(12):e83743.

Dale H, Hallan G, Hallan G, EspehaugB, Havelin LI, Engesaeter LB. Increasing risk of revision due to deep infection after hip arthroplasty. ActaOrthop. 2009;80(6):639-45.

Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am. 2013;95(24):2177-84.

DeCoster, Thomas A. MD; Bozorgnia, Shahram MD Antibiotic Beads, Journal of the American Academy of Orthopaedic Surgeons. 2008;16(11):674-8.

Brand RA, Mont MA, Manring MM. Biographical sketch: Themistocles Gluck. Clin. Orthop. Relat. Res. 1942.469:1525-7.

Charnley J. Anchorage of the femoral head prosthesis to the shaft of the femur. J. Bone Joint Surg. Br. 1960;42-B:28-30.

Charnley J. The classic: the bonding of prostheses to bone by cement. Clin. Orthop. Relat. Res. 2010;468:3149-59.

Buchholz HW, Gartmann HD. Infection prevention and surgical management of deep insidious infection in total endoprosthesis. Der Chirurg; Zeitschrift fur alleGebiete der operativenMedizen. 1972;43:446-53.

Walenkamp GH, Vree TB, van Rens TJ. Gentamicin-PMMA beads. Pharmacokinetic and nephrotoxicological study. Clin Orthop Relat Res. 1986;205:171-83.

Belt H, Neut D, Schenk W, van Horn JR, van der Mei HC, Busscher HJ. Gentamicin release from polymethylmethacrylate bone cements and Staphylococcus aureus biofilm formation. ActaOrthop Scand. 2000;71:625-29.

Lazzarini L, Mader JT, Calhoun JH. Osteomyelitis in long bones. J. Bone Joint Surg. Am. 2004;86-A:2305-18.

Sanz-Ruiz P, Carbo-Laso E, Del Real-Romero JC, Aran-Ais F, Ballesteros-Iglesias Y, Paz-Jimenez E. Microencapsulation of rifampicin: A technique to preserve the mechanical properties of bone cement. J Orthop Res. 2018;36:459-66.

Klemm K. Gentamicin-PMMA-beads in treating bone and soft tissue infections (author’s transl). ZentralblChir. 1979;104:934-42.

Walenkamp G. Small PMMA beads improve gentamicin release. ActaOrthop Scand. 1989;60:668-9.

Nelson CL, Griffin FM, Harrison BH, Cooper RE. In vitro elution characteristics of commercially and noncommercially prepared antibiotic PMMA beads. Clin. Orthop. Relat. Res. 1992;284:303-9.

BertazzoniMinelli E, Benini A, Magnan B, Bartolozzi P. Release of gentamicin and vancomycin from temporary human hip spacers in two-stage revision of infected arthroplasty. Journal of Antimicrobial Chemotherapy. 2004;53(2):329-34.

Arciola CR, Campoccia D, Speziale P, Montanaro L, Costerton JW. Biofilm formation in Staphylococcus implant infections. a review of molecular mechanisms and implications for biofilm-resistant materials. Biomaterials. 2012;33:5967-82.

Griffin JW, Guillot SJ, Redick JA, Browne JA. Removed antibiotic-impregnated cement spacers in two-stage revision joint arthroplasty do not show biofilm formation in vivo. J. Arthroplasty. 2012;27:1796-9.

Salvati EA, Callaghan JJ, Brause BD, Klein RF, Small RD. Reimplantation in infection. elution of gentamicin from cement and beads. Clin Orthop Relat Res. 1986;83-93.

Luu A, Syed F, Raman G, Bhalla A, Muldoon E, Hadley S. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. 2013;149:e1.

Thomes B, Murray P, Bouchier-Hayes D. Development of resistant strains of Staphylococcus epidermidis on gentamicin-loaded bone cement in vivo. J Bone Joint Surg Br. 2002;84:758-60.

Kendall RW, Duncan CP, Smith JA, Ngui-Yen J.H Persistence of bacteria on antibiotic loaded acrylic depots. A reason for caution. Clin Orthop Relat Res. 1996;329:273-80.