Local Inflammatory Reaction to Vancomycin-Laden Bone Cement

Abstract

Background: Antibiotic-laden bone cement is used commonly for fixation of primary hip arthroplasty and in the creation of spacers for treatment of orthopedic infections. We report an adverse event associated with the use of a vancomycin-laden bone cement spacer for treatment of a total knee arthroplasty infection. Case Presentation: A 60-year old Hispanic male developed chronic total knee arthroplasty infection caused by coagulase-negative staphylococci and anaerobic bacteria. He received systemic vancomycin and a vancomycin-laden cement spacer. During treatment, the patient developed a macular rash that resolved with discontinuation of intravenous vancomycin. He completed a six-week course of antibiotics uneventfully. When the patient returned to the operating room for revision arthroplasty, substantial local inflammation was found in the frozen sections. The vancomycin-laden cement spacer was removed and replaced with a spacer that did not contain vancomycin. No organisms were found on either routine microbiologic culture or broad-range polymerase-chain reaction studies. The Naranjo nomogram showed a "probable" adverse drug reaction to vancomycin cement. The patient received six more weeks of broad-spectrum antibiotics and eventually underwent successful revision arthroplasty. Conclusion: We believe that this patient had systemic and local allergic reactions to vancomycin. Because antibiotic-laden bone cement and other topical antibiotic preparations are used commonly in the treatment of surgical infections, we encourage providers to be aware of the possible adverse effects.