Airborne Exposure of Methyl Methacrylate During Simulated Total Hip Arthroplasty and Fabrication of Antibiotic Beads.

As the use of cement remains prevalent in orthopedic surgery, so do concerns over the safety of its active ingredient, methyl methacrylate (MMA). The Occupational Health and Safety Agency (OSHA) limits the airborne exposure to 100 parts per million (ppm) averaged over an 8 hour period. We measured MMA exposure to operating room personnel during simulated total hip arthroplasty (THA), antibiotic bead fabrication and simulated spill of MMA. Cumulative and peak exposures during simulated THA and antibiotic bead fabrication did not exceed OSHA limits of 100ppm. Vacuum mixing and greater distance from the vapor source reduced measured MMA exposure. Spilled MMA led to prolonged and elevated MMA levels. MMA levels returned to a negligible level in all scenarios by 20 minutes after mixing.

Sonication of antibiotic spacers predicts failure during two-stage revision for prosthetic knee and hip infections.

BACKGROUND: Periprosthetic joint infection is a leading cause of failure after two-stage reimplantation. One cause of relapse may be persistent subclinical infection. Difficulty exists in detecting biofilm-forming infections. Sonication disrupts biofilm and has led to higher rates of positive intraoperative cultures. QUESTIONS/PURPOSES: Our aims in this study were to determine (1) if sonication results were predictive of failure, including reinfection, at 2-year followup; and (2) whether sonication of antibiotic spacers at the time of reimplantation improves sensitivity of intraoperative cultures. METHODS: We prospectively followed 36 consecutive patients undergoing two-stage reimplantation for periprosthetic hip or knee infection. Minimum followup was 19 months (mean, 29.9 months; range, 19­38 months). Results of intraoperative cultures and sonicated antibiotic spacers were analyzed. RESULTS: Positive sonication results were predictive of failure as defined by reinfection at 2-year followup. Among the 18 patients who had positive sonication results, reinfection developed in nine patients (50%) compared with two of 18 patients (11%) with negative sonication results (odds ratio, 8.0; 95% CI, 1.2­69.0). Sonication of antibiotic spacers improved the sensitivity of intraoperative cultures from 45% to 82%. [corrected]. CONCLUSIONS: Sonication of antibiotic spacers appears to be useful in predicting failure attributable to recurrent infection after two-stage reimplantation. For patients with positive sonication cultures during reimplantation, more aggressive antimicrobial treatment may be indicated after reimplantation. LEVEL OF EVIDENCE: Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.