151
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Effects of gentamicin and gentamicin-RGD coatings on bone ingrowth and biocompatibility of cementless joint prostheses: an experimental study in rabbits. Acta Biomater 2011; 7:1274-80. [PMID: 21081183 DOI: 10.1016/j.actbio.2010.11.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/04/2010] [Accepted: 11/10/2010] [Indexed: 02/04/2023]
Abstract
Antimicrobial coatings are of interest as a means to improve infection prophylaxis in cementless joint arthroplasty. However, those coatings must not interfere with the essential bony integration of the implants. Gentamicin-hydroxyapatite (gentamicin-HA) and gentamicin-RGD (arginine-glycine-aspartate)-HA coatings have recently been shown to significantly reduce infection rates in a rabbit infection prophylaxis model. The purpose of the current study was to investigate the in vitro elution kinetics and in vivo effects of gentamicin-HA and gentamicin-RGD-HA coatings on new bone formation, implant integration and biocompatibility in a rabbit model. In vitro elution testing showed that 95% and 99% of the gentamicin was released after 12 and 24 h, respectively. The in vivo study comprised 45 rabbits in total, with six animals for each of the gentamicin-HA, gentamicin-RGD-HA group and control pure HA coating groups for the 4 week time period, and nine animals for each of the three groups for the 12 week observation period. A 2.0 mm steel K-wire with one of the coatings under test was placed in the intramedullary canal of the tibia. After 4 and 12 weeks the tibiae were harvested and three different areas (proximal metaphysis, shaft area, distal metaphysis) were assessed by quantitative and qualitative histology for new bone formation, direct implant-bone contact and the formation of multinucleated giant cells. The results exhibited high standard deviations in all subgroups. There was a trend towards better bone formation and better direct implant contact in the pure HA coating group compared with both gentamicin coatings after 4 and 12 weeks, which was, however, not statistically significant. The number of multinucleated giant cells did not differ significantly between the three groups at both time points. In summary, both gentamicin coatings with 99% release of gentamicin within 24 h revealed good biocompatibility and bony integration, which was not statistically significant different compared with pure HA coating. Limitations of the study are the high standard deviation of the results and the limited number of animals per time point.
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152
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Jensen T, Jakobsen T, Baas J, Nygaard JV, Dolatshahi-Pirouz A, Hovgaard MB, Foss M, Bünger C, Besenbacher F, Søballe K. Hydroxyapatite nanoparticles in poly-D,L-lactic acid coatings on porous titanium implants conducts bone formation. J Biomed Mater Res A 2011; 95:665-72. [PMID: 20725972 DOI: 10.1002/jbm.a.32863] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
It is well established in the field of biomaterials that hydroxyapatite (HA) may provide interesting osteoconductive properties. In this study, we investigated the osseointegrational effect of a 50/50 vol % composite of HA nanoparticles and poly-D,L-lactic acid (PDLLA) coated on model titanium bone implants in an in vivo animal model. The aim is to evaluate how the addition of HA to PDLLA may improve the bone formation and initial fixation of the implant. Two titanium implants coated with the PDLLA/HA composite and pure PDLLA, respectively, were implanted bilaterally in proximal part of humeri with a 2-mm peri-implant gap in 10 sheep. After 12 weeks, the remains of the coatings were present on 20.3 and 19.8% of PDLLA/HA composite- and PDLLA-coated implants, respectively. It was observed that newly formed bone (39.3%) and fibrous tissue (58.3%) had replaced the PDLLA/HA composite, whereas pure PDLLA was replaced almost completely by fibrous tissue (96.2%). Consequently, the PDLLA/HA composite-coated implants were better fixated as confirmed by push-out tests. Using quantification of peri-implant tissue and implant fixation as parameters, the present findings, therefore, clearly reveal that the addition of nanoparticulate HA to a PDLLA coating on titanium implants increases osseointegration.
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Affiliation(s)
- Thomas Jensen
- Orthopaedic Research Lab, Department of Orthopaedics, University Hospital of Aarhus, Aarhus C, Denmark
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153
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Variola F, Brunski J, Orsini G, de Oliveira PT, Wazen R, Nanci A. Nanoscale surface modifications of medically relevant metals: state-of-the art and perspectives. NANOSCALE 2011; 3:335-53. [PMID: 20976359 PMCID: PMC3105323 DOI: 10.1039/c0nr00485e] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Evidence that nanoscale surface properties stimulate and guide various molecular and biological processes at the implant/tissue interface is fostering a new trend in designing implantable metals. Cutting-edge expertise and techniques drawn from widely separated fields, such as nanotechnology, materials engineering and biology, have been advantageously exploited to nanoengineer surfaces in ways that control and direct these processes in predictable manners. In this review, we present and discuss the state-of-the-art of nanotechnology-based approaches currently adopted to modify the surface of metals used for orthopedic and dental applications, and also briefly consider their use in the cardiovascular field. The effects of nanoengineered surfaces on various in vitro molecular and cellular events are firstly discussed. This review also provides an overview of in vivo and clinical studies with nanostructured metallic implants, and addresses the potential influence of nanotopography on biomechanical events at interfaces. Ultimately, the objective of this work is to give the readership a comprehensive picture of the current advances, future developments and challenges in the application of the infinitesimally small to biomedical surface science. We believe that an integrated understanding of the in vitro and particularly of the in vivo behavior is mandatory for the proper exploitation of nanostructured implantable metals and, indeed, of all biomaterials.
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Affiliation(s)
- Fabio Variola
- Faculty of Engineering, Department of Mechanical Engineering, University of Ottawa, Ottawa, ON, K1N 6N5 (Canada)
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, H3C 3J7 (Canada)
| | - John Brunski
- Division of Plastic & Reconstructive Surgery, Department of Surgery PSRL, School of Medicine, Stanford University, 257 Campus Drive Stanford, CA 94305 (USA)
| | - Giovanna Orsini
- Department of Clinical Sciences and Stomatology, University of Marche, Via Tronto 10, 66026 Ancona (Italy)
| | - Paulo Tambasco de Oliveira
- Department of Morphology, Stomatology and Physiology, University of São Paulo, Ribeirão Preto, SP, 14040-904 (Brazil)
| | - Rima Wazen
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, H3C 3J7 (Canada)
| | - Antonio Nanci
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculté de Médecine Dentaire, Université de Montréal, Montréal, QC, H3C 3J7 (Canada)
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154
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De Giglio E, Cometa S, Ricci M, Cafagna D, Savino A, Sabbatini L, Orciani M, Ceci E, Novello L, Tantillo G, Mattioli-Belmonte M. Ciprofloxacin-modified electrosynthesized hydrogel coatings to prevent titanium-implant-associated infections. Acta Biomater 2011; 7:882-91. [PMID: 20659594 DOI: 10.1016/j.actbio.2010.07.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 07/12/2010] [Accepted: 07/16/2010] [Indexed: 11/27/2022]
Abstract
New promising and versatile materials for the development of in situ sustained release systems consisting of thin films of either poly(2-hydroxyethyl methacrylate) or a copolymer based on poly(ethylene-glycol diacrylate) and acrylic acid were investigated. These polymers were electrosynthesized directly on titanium substrates and loaded with ciprofloxacin (CIP) either during or after the synthesis step. X-ray photoelectron spectroscopy was used to check the CIP entrapment efficiency as well as its surface availability in the hydrogel films, while high-performance liquid chromatography was employed to assess the release property of the films and to quantify the amount of CIP released by the coatings. These systems were then tested to evaluate the in vitro inhibition of methicillin-resistant Staphylococcus aureus (MRSA) growth. Moreover, a model equation is proposed which can easily correlate the diameter of the inhibition haloes with the amount of antibiotic released. Finally, MG63 human osteoblast-like cells were employed to assess the biocompatibility of CIP-modified hydrogel coatings.
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155
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Liakopoulos A, Foka A, Vourli S, Zerva L, Tsiapara F, Protonotariou E, Dailiana Z, Economou M, Papoutsidou E, Koutsia-Carouzou C, Anastassiou ED, Diza E, Zintzaras E, Spiliopoulou I, Petinaki E. Aminoglycoside-resistant staphylococci in Greece: prevalence and resistance mechanisms. Eur J Clin Microbiol Infect Dis 2011; 30:701-5. [PMID: 21222013 DOI: 10.1007/s10096-010-1132-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 12/17/2010] [Indexed: 10/18/2022]
Affiliation(s)
- A Liakopoulos
- Department of Microbiology, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
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156
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Nizegorodcew T, Palmieri G, Marzetti E. Antibiotic-Coated Nails in Orthopedic and Trauma Surgery: State of the Art. Int J Immunopathol Pharmacol 2011; 24:125-8. [DOI: 10.1177/03946320110241s223] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Optimal management of deep infections in orthopedic and trauma surgery is often challenging. Traditional prophylactic and treatment approaches are based on the systemic administration of relatively high doses of antibiotics, which may result in a number of side effects. Furthermore, systemically administered antimicrobials may not reach adequate concentration at the desired site. Finally, traditional approaches are based on two-step protocols, thus delaying definite fixation. In recent years, antibiotic-coated intramedullary nails (ACINs) have been introduced, which offer the advantage of delivering antibiotics locally, thus increasing their local concentrations and length of action. In addition, ACINs offer the great advantage of combining antimicrobial prophylaxis / treatment and stabilization in a single step. Preliminary evidence by small clinical studies appears to support the effectiveness of ACINs in the management of chronic osteomyelitis and infected non-unions, with high rates of infection eradication and bone union. However, randomized clinical trials are needed to definitely establish ACINs' effectiveness and safety.
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Affiliation(s)
- T. Nizegorodcew
- Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Largo A. Gemelli 1, Rome, 00168 Italy
| | - G. Palmieri
- Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Largo A. Gemelli 1, Rome, 00168 Italy
| | - E. Marzetti
- Department of Orthopedics and Traumatology, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Largo A. Gemelli 1, Rome, 00168 Italy
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157
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Robinson DA, Bechtold JE, Carlson CS, Evans RB, Conzemius MG. Development of a fracture osteomyelitis model in the rat femur. J Orthop Res 2011; 29:131-7. [PMID: 20602463 DOI: 10.1002/jor.21188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Osteomyelitis contributes significantly to fracture morbidity. Our objective was to develop a model of induced implant-associated osteomyelitis following fracture repair by modifying an existing rat femur fracture model. Thirty male Sprague-Dawley rats were divided into three groups (Control, Staphylococcus aureus, S. aureus + ceftriaxone). The closed femur fracture model (right femur), stabilized with an intramedullary pin, was combined with inoculation of 10(4) colony-forming units (CFU) of S. aureus. Radiographs were obtained immediately after surgery and at weeks 1, 2, and 3 and were evaluated by individuals blinded to treatment group. At necropsy the CFU of S. aureus per femur and pin were determined and synovial tissue and blood were cultured. The fractured femur from two rats in each group was evaluated histologically. A statistically significant difference in the CFU/femur and CFU/pin was found across treatment groups, with the highest CFU in the S. aureus group and the lowest in the Control group. Cultures of synovial tissue were positive in 11/19 of inoculated limbs. Osteomyelitis was present both radiographically and histopathologically in both S. aureus groups but not in the controls. No rats were systemically ill or had positive blood cultures at the study endpoint. This model will be useful for the evaluation of treatments or prophylactics designed for use in implant-associated osteomyelitis.
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Affiliation(s)
- Duane A Robinson
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota, 1352 Boyd Avenue, St Paul, Minnesota 55108, USA
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158
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Wong SY, Moskowitz JS, Veselinovic J, Rosario RA, Timachova K, Blaisse MR, Smith RC, Klibanov AM, Hammond PT. Dual functional polyelectrolyte multilayer coatings for implants: permanent microbicidal base with controlled release of therapeutic agents. J Am Chem Soc 2010; 132:17840-8. [PMID: 21105659 PMCID: PMC3218101 DOI: 10.1021/ja106288c] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Here we present a new bifunctional layer-by-layer (LbL) construct made by combining a permanent microbicidal polyelectrolyte multilayered (PEM) base film with a hydrolytically degradable PEM top film that offers controlled and localized delivery of therapeutics. Two degradable film architectures are presented: (1) bolus release of an antibiotic (gentamicin) to eradicate initial infection at the implant site, or (2) sustained delivery of an anti-inflammatory drug (diclofenac) to cope with inflammation at the site of implantation due to tissue injury. Each degradable film was built on top of a permanent base film that imparts the implantable device surface with microbicidal functionality that prevents the formation of biofilms. Controlled-delivery of gentamicin was demonstrated over hours and that of diclofenac over days. Both drugs retained their efficacy upon release. The permanent microbicidal base film was biocompatible with A549 epithelial cancer cells and MC3T3-E1 osteoprogenitor cells, while also preventing bacteria attachment from turbid media for the entire duration of the two weeks studied. The microbicidal base film retains its functionality after the biodegradable films have completely degraded. The versatility of these PEM films and their ability to prevent biofilm formation make them attractive as coatings for implantable devices.
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Affiliation(s)
- Sze Yinn Wong
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Joshua S. Moskowitz
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Jovana Veselinovic
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Ryan A. Rosario
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Ksenia Timachova
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
- Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Michael R. Blaisse
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Renée C. Smith
- Harvard-MIT Division of Health Sciences and Technology (HST), Cambridge MA 02139, USA
| | - Alexander M. Klibanov
- Departments of Chemistry and Biological Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
| | - Paula T. Hammond
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge MA 02139, USA
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159
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Vester H, Wildemann B, Schmidmaier G, Stöckle U, Lucke M. Gentamycin delivered from a PDLLA coating of metallic implants: In vivo and in vitro characterisation for local prophylaxis of implant-related osteomyelitis. Injury 2010; 41:1053-9. [PMID: 20541756 DOI: 10.1016/j.injury.2010.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 04/30/2010] [Accepted: 05/06/2010] [Indexed: 02/02/2023]
Abstract
Locally applied antibiotics support prophylaxis of highly feared implant associated infections. Implant coatings with poly(D,L-lactide) (PDLLA)/gentamicin seem to be a promising approach. Aims of this study were to analyse the release kinetics of gentamicin in vivo, in vitro, to analyse the antibacterial efficacy,the resistance development and its impact on osteoblasts. For the in vitro release experiments titanium implants were coated with PDLLA/gentamicin and the antibiotic release in aqueous solution was analysed at 20 time points (from 10 s to 110 days). For the in vivo experiments PDLLA/gentamicin-coated kirschner wires were implanted in the tibiae of 18 rats. Gentamicin concentration in the bone was analysed at several time points (n = 3 each, 1 h to 7 days). Bactericidal efficacy, bacterial adhesion on the implants and resistance development were tested. AP activity, cell count and CICP expression of osteoblasts were analysed. Gentamicin was released rapidly with an initial burst in aqueous solution and followed by a slow release. Similarly, in vivo gentamicin concentration reached a high peak initially followed by a decrease to a low level. No development of resistance was observed in the investigated setting, the antibacterial efficacy was not affected by the coating process and significantly fewer bacteria were attached to the implant. Osteoblasts were not negatively affected by the gentamicin released from the coating. PDLLA/gentamicin coating resulted in a desired antibiotic peak concentration within the bone. Bacterial adhesion was successfully prevented. No bacterial resistances were developed. This coating seems to be a suitable supplement for prophylaxis of implant-associated infections.
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Affiliation(s)
- Helen Vester
- Department of Traumatology, MRI, Klinikum rechts der lsar, Technische Universität München, Ismaningerstrasse 22, 81675 München, Germany.
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160
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Khalilpour P, Lampe K, Wagener M, Stigler B, Heiss C, Ullrich MS, Domann E, Schnettler R, Alt V. Ag/SiO(x)C(y) plasma polymer coating for antimicrobial protection of fracture fixation devices. J Biomed Mater Res B Appl Biomater 2010; 94:196-202. [PMID: 20524195 DOI: 10.1002/jbm.b.31641] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Implant-related infections are often devastating situations in orthopaedic trauma surgery particularly if multiresistant bacteria are involved. Protection of the implant surface by an antimicrobial coating exhibiting activity against multiresistant bacterial strains is of high interest. Aim of this study was to investigate the antimicrobial effects of an Ag/SiO(x)C(y) plasma polymer coating for fracture fixation devices, such as nails, plates, and external fixators, including tests against methicillin-resistant Staphylococcus aureus (MRSA) and its biocompatibility. The antimicrobial activity of the coating deposited onto 12 x 3 mm(2) stainless steel implants was tested in vitro against Staphylococcus aureus, Staphylococcus epidermidis, and MRSA using different testing methods (ASTM E-2810, JIS Z 2801, proliferation assay). Additionally, the coated devices were implanted into the paravertebral muscle of rabbits and explanted after 2, 7, 14, and 28 days to test the remaining ex vivo antimicrobial activity. For biocompatibility assessment the Ag/SiO(x)C(y) plasma polymer coating was tested in vitro according to ISO 10993-5. The Ag/SiO(x)C(y) coating exhibited excellent antimicrobial activity against all tested bacterial strains in all three in vitro tests. Ex vivo testing proved suppression of more than 99.9 % of bacterial proliferation by the coating compared to non-coated samples even after 28 days. ISO 10993-5 showed good biocompatibility of the coating without any indications of cytotoxic effects. In summary, Ag/SiO(x)C(y) plasma polymer coating showed excellent antimicrobial activity including effectiveness against MRSA and good in vitro biocompatibility. Therefore, it possesses high potential as a prophylactic agent in orthopaedic trauma surgery.
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161
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Bernthal NM, Stavrakis AI, Billi F, Cho JS, Kremen TJ, Simon SI, Cheung AL, Finerman GA, Lieberman JR, Adams JS, Miller LS. A mouse model of post-arthroplasty Staphylococcus aureus joint infection to evaluate in vivo the efficacy of antimicrobial implant coatings. PLoS One 2010; 5:e12580. [PMID: 20830204 PMCID: PMC2935351 DOI: 10.1371/journal.pone.0012580] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 08/10/2010] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs. METHODOLOGY/PRINCIPAL FINDINGS To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5x10(3) and 5x10(4) CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acute joint infection. In contrast, mice inoculated with 5x10(2) CFUs developed a low-grade infection, resembling a more chronic infection. Ex vivo bacterial counts highly correlated with in vivo bioluminescence signals and EGFP-neutrophil fluorescence of LysEGFP mice was used to measure the infection-induced inflammation. Furthermore, biofilm formation on the implants was visualized at 7 and 14 postoperative days by variable-pressure scanning electron microscopy (VP-SEM). Using this model, a minocycline/rifampin-impregnated bioresorbable polymer implant coating was effective in reducing the infection, decreasing inflammation and preventing biofilm formation. CONCLUSIONS/SIGNIFICANCE Taken together, this mouse model may represent an alternative pre-clinical screening tool to evaluate novel in vivo therapeutic strategies before studies in larger animals and in human subjects. Furthermore, the antibiotic-polymer implant coating evaluated in this study was clinically effective, suggesting the potential for this strategy as a therapeutic intervention to combat post-arthroplasty infections.
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Affiliation(s)
- Nicholas M. Bernthal
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Alexandra I. Stavrakis
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Fabrizio Billi
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - John S. Cho
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Thomas J. Kremen
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Scott I. Simon
- Department of Biomedical Engineering, University of California Davis, Davis, California, United States of America
| | - Ambrose L. Cheung
- Department of Microbiology and Immunology, Dartmouth Medical School, Hanover, New Hampshire, United States of America
| | - Gerald A. Finerman
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Jay R. Lieberman
- New England Musculoskeletal Institute, Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, United States of America
| | - John S. Adams
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| | - Lloyd S. Miller
- Orthopaedic Hospital Research Center, Orthopaedic Hospital Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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162
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Campoccia D, Montanaro L, Speziale P, Arciola CR. Antibiotic-loaded biomaterials and the risks for the spread of antibiotic resistance following their prophylactic and therapeutic clinical use. Biomaterials 2010; 31:6363-77. [DOI: 10.1016/j.biomaterials.2010.05.005] [Citation(s) in RCA: 300] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 05/07/2010] [Indexed: 12/28/2022]
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163
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Li H, Ogle H, Jiang B, Hagar M, Li B. Cefazolin embedded biodegradable polypeptide nanofilms promising for infection prevention: a preliminary study on cell responses. J Orthop Res 2010; 28:992-9. [PMID: 20162715 PMCID: PMC3699871 DOI: 10.1002/jor.21115] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 01/11/2010] [Indexed: 02/04/2023]
Abstract
Implant-associated infection is a serious complication in orthopedic surgery, and endowing implant surfaces with antibacterial properties could be one of the most promising approaches for preventing such infection. In this study, we developed cefazolin loaded biodegradable polypeptide multilayer nanofilms on orthopedic implants. We found that the amount of cefazolin released could be tuned. A high local concentration of cefazolin was achieved within the first a few hours and therefore may inhibit bacterial colonization in the critical postimplantation period. The developed cefazolin loaded nanofilms showed their in vitro efficacy against Staphylococcus aureus; the more antibiotics loaded, the longer the nanocoated implant had antibacterial properties. More interestingly, antibiotic-loaded polypeptide multilayer nanofilms also improved osteoblast bioactivity including cell viability and proliferation. These findings suggested that biodegradable polypeptide multilayer nanofilms as antibiotic carriers at the implant/tissue interface are compatible with human cells such as osteoblasts and bactericidal to bacteria such as S. aureus. These characteristics could be promising for preventing implant-associated infection and potentially improving bone healing.
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Affiliation(s)
- Hongshuai Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Heather Ogle
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Bingbing Jiang
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Michael Hagar
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
- WVNano Initiative, Morgantown, WV 26506, USA
- Department of Chemical Engineering, College of Engineering and Mineral Resources, West Virginia University, Morgantown, WV 26506, USA
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164
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Moskowitz JS, Blaisse MR, Samuel RE, Hsu HP, Harris MB, Martin SD, Lee JC, Spector M, Hammond PT. The effectiveness of the controlled release of gentamicin from polyelectrolyte multilayers in the treatment of Staphylococcus aureus infection in a rabbit bone model. Biomaterials 2010; 31:6019-30. [PMID: 20488534 DOI: 10.1016/j.biomaterials.2010.04.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 04/05/2010] [Indexed: 11/17/2022]
Abstract
While the infection rate of orthopedic implants is low, the required treatment, which can involve six weeks of antibiotic therapy and two additional surgical operations, is life threatening and expensive, and thus motivates the development of a one-stage re-implantation procedure. Polyelectrolyte multilayers incorporating gentamicin were fabricated using the layer-by-layer deposition process for use as a device coating to address an existing bone infection in a direct implant exchange operation. The films eluted about 70% of their payload in vitro during the first three days and subsequently continued to release drug for more than four additional weeks, reaching a total average release of over 550 microg/cm(2). The coatings were demonstrated to be bactericidal against Staphylococcus aureus, and degradation products were generally nontoxic towards MC3T3-E1 murine preosteoblasts. Film-coated titanium implants were compared to uncoated implants in an in vivo S. aureus bone infection model. After a direct exchange procedure, the antimicrobial-coated devices yielded bone homogenates with a significantly lower degree of infection than uncoated devices at both day four (p < 0.004) and day seven (p < 0.03). This study has demonstrated that a self-assembled ultrathin film coating is capable of effectively treating an experimental bone infection in vivo and lays the foundation for development of a multi-therapeutic film for optimized, synergistic treatment of pain, infection, and osteomyelitis.
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Affiliation(s)
- Joshua S Moskowitz
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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165
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Fei J, Yu HJ, Pan CJ, Zhao CH, Zhou YG, Wang Y. Efficacy of a norvancomycin-loaded, PDLLA-coated plate in preventing early infection of rabbit tibia fracture. Orthopedics 2010; 33. [PMID: 20506956 DOI: 10.3928/01477447-20100329-06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite improvements in surgical techniques and implant designs in orthopedic surgery, implantation-associated infections are still a challenging problem for surgeons. The goal of this study was to evaluate the efficacy of a norvancomycin-loaded, PDLLA-coated stainless steel plate vs an uncoated stainless steel plate in a rabbit model (n=50). The norvancomycin was delivered from a biodegradable poly(D,L-lactide) (PDLLA) coating of a stainless steel plate. Intraoperatively, rabbit tibia fractures were contaminated with Staphylococcus aureus (10(5) colony forming units) after plate implantation. The implants were either uncoated or coated with PDLLA and norvancomycin. In vivo drug release profiles showed that the norvancomycin release rate was decreased by increasing the time. The norvancomycin concentration in the tissue around the plate was higher than the minimum inhibitory concentration on the 14th day after implantation surgery. The animals were followed up for 28 days. Radiographic examinations were performed, and C-reactive protein and erythrocyte sedimentation rate were determined. Infection was evaluated by histological, microbiological, and radiological analysis. Eight of 25 rabbits (32%) implanted with the norvancomycin-loaded, PDLLA-coated plates were infected. Twenty-three of 25 rabbits (92%) implanted with the uncoated plates were infected (P<.05). The norvancomycin-loaded, PDLLA-coated plate may be used to treat open fractures to reduce the incidence of early infection.
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Affiliation(s)
- Jun Fei
- Traumatic Centre, Research Institute of Surgery, Daping Hospital, Third Military Medical College, Chongqing, 400042, China
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166
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Shimazaki T, Miyamoto H, Ando Y, Noda I, Yonekura Y, Kawano S, Miyazaki M, Mawatari M, Hotokebuchi T. In vivo antibacterial and silver-releasing properties of novel thermal sprayed silver-containing hydroxyapatite coating. J Biomed Mater Res B Appl Biomater 2010; 92:386-9. [PMID: 19904818 DOI: 10.1002/jbm.b.31526] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One of the serious postoperative complications associated with joint replacement is bacterial infection. In addressing this problem, we have previously described the development of a novel thermal spraying technology combining silver (Ag) showing antibacterial activity with hydroxyapatite (HA) displaying good biocompatibility and osteoconductivity, and reported the in vitro properties. This study evaluated serum Ag ion concentrations and antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) using a subcutaneous rat model. HA loaded with 3 wt % of silver oxide (Ag-HA) and plain HA were sprayed on the surface of titanium disks. Ag-HA- or HA-coated samples were implanted into the back subcutaneous pockets of male Sprague-Dawley rats. Mean serum Ag ion concentration in the Ag-HA group increased to more than 50 ppb by 48 h after implantation, then decreased gradually to baseline levels. Mean (+/- standard error of the mean) number of viable MRSA on HA coating was (1.5 +/- 0.5) x 10(5), which is significantly more than the (1.1 +/- 0.4) x 10(4) on Ag-HA coating (p < 0.001). Ag-HA coating offers good abilities to release Ag ions and kill MRSA in vivo.
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Affiliation(s)
- Takafumi Shimazaki
- Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
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167
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Arruebo M, Vilaboa N, Santamaria J. Drug delivery from internally implanted biomedical devices used in traumatology and in orthopedic surgery. Expert Opin Drug Deliv 2010; 7:589-603. [DOI: 10.1517/17425241003671544] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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168
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Abstract
This manuscript reviews about titanium surface modification techniques for its application in orthopaedic and dental implants. There are a few limitations in the long term prognosis of orthopaedic and dental implants. Poor osseointegration with bone, periimplant infection leading to implant failure and short term longevity demanding revision surgery, are to mention a few. Micro- and nanoscale modification of titanium surface using physicochemical, morphological and biochemical approaches have resulted in higher bone to implant contact ratio and improved osseointegration. With recent advances in micro, nano-fabrication techniques and multidisciplinary research studies focusing on bridging biomaterials for medical applications, TiO2 nanotubes have been extensively studied for implant applications. The need for titanium implant surface that can closely mimic the nanoscale architecture of human bone has become a priority. For such purpose, TiO2 nanotubes of different dimensions and architectural fashions at the nanoscale level are being evaluated. This manuscript discusses in brief about the in-vitro and in-vivo studies on titanium surface modification techniques. This manuscript also addresses the recent studies done on such nanotubular surfaces for the effective delivery of osteoinductive growth factors and anti bacterial/ anti inflammatory drugs to promote osseointegration and prevent peri-implant infection.
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169
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Noda I, Miyaji F, Ando Y, Miyamoto H, Shimazaki T, Yonekura Y, Miyazaki M, Mawatari M, Hotokebuchi T. Next Generation Antibacterial Hydroxyapatite Coating: Antibacterial Activity of Ag Ions in Serum. ACTA ACUST UNITED AC 2010. [DOI: 10.4303/bda/d101102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- I. Noda
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan
| | - F. Miyaji
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan
| | - Y. Ando
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - H. Miyamoto
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - T. Shimazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Y. Yonekura
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - M. Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - M. Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - T. Hotokebuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
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170
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Aykut S, Öztürk A, Özkan Y, Yanik K, İlman AA, Özdemir RM. Evaluation and comparison of the antimicrobial efficacy of teicoplanin- and clindamycin-coated titanium implants. ACTA ACUST UNITED AC 2010; 92:159-63. [DOI: 10.1302/0301-620x.92b1.22134] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We studied the effects of coating titanium implants with teicoplanin and clindamycin in 30 New Zealand White rabbits which were randomly assigned to three groups. The intramedullary canal of the left tibia of each rabbit was inoculated with 500 colony forming units of Staphylococcus aureus. Teicoplanin-coated implants were implanted into rabbits in group 1, clindamycin-coated implants into rabbits in group 2, and uncoated implants into those in group 3. All the rabbits were killed one week later. The implants were removed and cultured together with pieces of tibial bone and wound swabs. The rate of colonisation of the organisms in the three groups was compared. Organisms were cultured from no rabbits in group 1, one in group 2 but from all in group 3. There was no significant difference between groups 1 and 2 (p = 1.000). There were significant differences between groups 1 and 3 and groups 2 and 3 (p < 0.001). Significant protection against bacterial colonisation and infection was found with teicoplanin- and clindamycin-coated implants in this experimental model.
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Affiliation(s)
- S. Aykut
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - A. Öztürk
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - Y. Özkan
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
| | - K. Yanik
- Department of Surgery, Veterinary Faculty Uludag University, Görükle, 16059 Nilüfer, Bursa, Turkey
| | - A. A. İlman
- Dogal Yasami Koruma Merkezi, 16059 Nilüfer, Bursa, Turkey
| | - R. M. Özdemir
- Clinic of Orthopaedics and Traumatology Bursa High Specialty Research and Training Hospital, Yildrim 16630, Bursa, Turkey
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171
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Lindsey BA, Clovis NB, Smith ES, Salihu S, Hubbard DF. An animal model for open femur fracture and osteomyelitis: Part I. J Orthop Res 2010; 28:38-42. [PMID: 19637274 DOI: 10.1002/jor.20960] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infection is an everyday problem in orthopaedics and is quite common in open fracture management. To study this process and provide a basis to prevent infection, we developed a model that includes trauma (blunt fracture in the fashion of Bonnarens and Einhorn), surgical stabilization (standardized intramedullary K-wire fixation), and infection (Staphylococcus aureus inoculum). In this two-part study, we found that 10(2) colony-forming units of inoculum produced an optimal infection rate of 90-100%, which substantially challenged the immune system without overwhelming sepsis. We hypothesized that, in traumatic fractures, there is a specific immunological response that may lead to an increased rate of infection. In Part 2, we demonstrated immunosuppression (decreased Interleukin-12 levels) at days 6, 10, and 12 after fracture fixation versus nonfractured control groups (p < 0.05). This study describes a rat model of femur factures with osteomyelitis that allows investigation of posttraumatic immunosuppression.
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Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, P.O. Box 9196, Health Sciences Center, Morgantown, West Virginia 26506-9196, USA.
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172
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Lindsey BA, Clovis NB, Smith ES, Salihu S, Hubbard DF. An animal model for open femur fracture and osteomyelitis--Part II: Immunomodulation with systemic IL-12. J Orthop Res 2010; 28:43-7. [PMID: 19623664 DOI: 10.1002/jor.20959] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Infection resulting from open fracture is a common problem in orthopedics. The purpose of this project was to study the effect of Interleukin-12 (IL-12) systemic therapy on a previously established open fracture model. One hundred seven male Sprague-Dawley rats were assigned to five groups: (1) normal (baseline), (2) control (controlled for anesthesia), (3) fracture, (4) staph, and (5) staph and IL-12 (SIL). Each group was divided into four time periods: 6, 10, 14, and 21 days after injury and fixation. The operative groups had a standardized femur fracture and fixation using a Kirschner wire as an intramedullary device. The two infection groups (staph and SIL) were inoculated with Staphylococcus aureus following fracture and fixed with an identical technique. The SIL group was treated with systemic IL-12 for a total of 10 doses over 10 days. Significantly decreased serum IL-12 levels were noted at day 10 in the operative groups compared to the normal and control groups. The SIL group showed significantly higher macrophage activation levels and total platelet counts at day 21 compared to all the other groups. The overall infection rate was not changed by IL-12 supplementation; however, bacterial qualitative growth scores were significantly lower in the SIL group at day 10, which corresponded to the lowest level of systemic IL-12 in the fracture group.
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Affiliation(s)
- Brock A Lindsey
- Department of Orthopaedics, West Virginia University, P.O. Box 9196 Health Sciences Center, Morgantown, West Virginia 26506-9196, USA.
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173
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Ando Y, Miyamoto H, Noda I, Sakurai N, Akiyama T, Yonekura Y, Shimazaki T, Miyazaki M, Mawatari M, Hotokebuchi T. Calcium phosphate coating containing silver shows high antibacterial activity and low cytotoxicity and inhibits bacterial adhesion. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2010. [DOI: 10.1016/j.msec.2009.09.015] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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174
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ANDO YOSHIKI, MIYAMOTO HIROSHI, NODA IWAO, MIYAJI FUMIAKI, SHIMAZAKI TAKAFUMI, YONEKURA YUTAKA, MIYAZAKI MASAKI, MAWATARI MASAAKI, HOTOKEBUCHI TAKAO. Effect of Bacterial Media on the Evaluation of the Antibacterial Activity of a Biomaterial Containing Inorganic Antibacterial Reagents or Antibiotics. Biocontrol Sci 2010; 15:15-9. [DOI: 10.4265/bio.15.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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175
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Unnanuntana A, Bonsignore L, Shirtliff ME, Greenfield EM. The effects of farnesol on Staphylococcus aureus biofilms and osteoblasts. An in vitro study. J Bone Joint Surg Am 2009; 91:2683-92. [PMID: 19884443 PMCID: PMC2883444 DOI: 10.2106/jbjs.h.01699] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bacterial biofilms play a major role in chronic orthopaedic infections. Recently, farnesol (an antifungal agent) has been shown to express antimicrobial activities against Staphylococcus aureus and Streptococcus mutans. However, the effects of farnesol on the formation of bacterial biofilms on orthopaedic biomaterials and its effects on osteoblasts have not been investigated, to our knowledge, and are therefore the focus of this study. METHODS Biofilms of Staphylococcus aureus (Seattle 1945(GFPuvr)) were grown on titanium alloy discs. The effects of soluble farnesol on biofilm formation with or without gentamicin were examined with fluorescence microscopy and in quantitative cultures. The effect of farnesol coated on titanium alloy discs was also investigated, as was the effect of the agent on MC3T3-E1 pre-osteoblastic cells cultured on titanium alloy discs. RESULTS Soluble farnesol at a 30-mM concentration reduced the number of viable bacteria 10(4)-fold and completely inhibited biofilm formation. Low concentrations of soluble farnesol (0.03 to 3 mM) did not inhibit biofilm formation and did not potentiate the effect of a submaximal concentration of gentamicin. Dried farnesol on titanium alloy discs reduced the number of viable bacteria fiftyfold. The effect of farnesol on bacterial biofilm formation lasted for at least three days. Soluble farnesol added after the biofilm had already formed also reduced the final number of viable bacteria, by fifty-six-fold. Soluble farnesol (3-mM and 30-mM concentrations) inhibited spreading of the MC3T3-E1 cells. CONCLUSIONS In vitro, a high concentration of farnesol (30 mM) shows antimicrobial properties against bacterial biofilms; however, it also has a negative effect on pre-osteoblasts. Farnesol can also express antimicrobial activity when predried on titanium discs and when added to preformed biofilms.
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Affiliation(s)
- Aasis Unnanuntana
- Departments of Orthopaedics (A.U., L.B., and E.M.G), Pathology (L.B. and E.M.G.), and Physiology and Biophysics (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address for A. Unnanuntana:
| | - Lindsay Bonsignore
- Departments of Orthopaedics (A.U., L.B., and E.M.G), Pathology (L.B. and E.M.G.), and Physiology and Biophysics (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address for A. Unnanuntana:
| | - Mark E. Shirtliff
- Department of Microbiology and Immunology, School of Medicine, University of Maryland at Baltimore, 650 West Baltimore Street, Baltimore, MD 21201
| | - Edward M. Greenfield
- Departments of Orthopaedics (A.U., L.B., and E.M.G), Pathology (L.B. and E.M.G.), and Physiology and Biophysics (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106. E-mail address for A. Unnanuntana:
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176
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Nandi SK, Mukherjee P, Roy S, Kundu B, De DK, Basu D. Local antibiotic delivery systems for the treatment of osteomyelitis – A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2009. [DOI: 10.1016/j.msec.2009.07.014] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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177
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Zhao L, Chu PK, Zhang Y, Wu Z. Antibacterial coatings on titanium implants. J Biomed Mater Res B Appl Biomater 2009; 91:470-80. [DOI: 10.1002/jbm.b.31463] [Citation(s) in RCA: 645] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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178
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Koseki H, Shiraishi K, Tsurumoto T, Asahara T, Baba K, Taoda H, Terasaki N, Shindo H. Bactericidal performance of photocatalytic titanium dioxide particle mixture under ultraviolet and fluorescent light: an in vitro
study. SURF INTERFACE ANAL 2009. [DOI: 10.1002/sia.3087] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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179
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Noda I, Miyaji F, Ando Y, Miyamoto H, Shimazaki T, Yonekura Y, Miyazaki M, Mawatari M, Hotokebuchi T. Development of novel thermal sprayed antibacterial coating and evaluation of release properties of silver ions. J Biomed Mater Res B Appl Biomater 2009; 89:456-465. [PMID: 18937261 DOI: 10.1002/jbm.b.31235] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Several studies have addressed the use of antibacterial coating to reduce implant-associated infections. In this study, novel silver (Ag)-containing calcium-phosphate (CP) coating technology based on the thermal spraying method was developed. The coating's physical and chemical properties, in vitro antibacterial activity, hydroxyapatite (HA)-forming ability, and release of Ag ions were evaluated. An amorphous structure of the coating was confirmed by X-ray diffraction, and Ag residue in the coating was determined by elementary analysis. The coating showed strong antibacterial activity to methicillin-resistant Staphylococcus aureus in fetal bovine serum (FBS) along with HA-forming ability in simulated body fluid. Therefore, it is expected that the coating would confer antibacterial and bone bonding abilities to the implant surface. Time course release testing of Ag ions from the coating on immersion in FBS showed pronounced Ag release for up to 24 h after immersion, with consistent strong antibacterial activity at the early postoperative stage. In repeated testing, the amount of released Ag ions was about 6500 parts per billion (ppb, microg/L) for the first release test, after which it gradually decreased. However, retention of significant release of Ag ions after a sixth repeat implies that Ag release from the coating is slow in FBS.
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Affiliation(s)
- Iwao Noda
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan
| | - Fumiaki Miyaji
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan
| | - Yoshiki Ando
- Research Department, Japan Medical Materials Corporation, Osaka 532-0003, Japan.,Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Hiroshi Miyamoto
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Takafumi Shimazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Yutaka Yonekura
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Masaki Miyazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
| | - Takao Hotokebuchi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan
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180
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Xiao J, Zhu Y, Liu Y, Zeng Y, Xu F. A composite coating of calcium alginate and gelatin particles on Ti6Al4V implant for the delivery of water soluble drug. J Biomed Mater Res B Appl Biomater 2009; 89:543-550. [PMID: 19048634 DOI: 10.1002/jbm.b.31246] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A composite coating on Ti6Al4V implant was prepared from alginate and gelatin particles through a dip-coating method to control the release of the water soluble drug gentamicin and improve the surface properties of the implant. Gentamicin was dissolved in the coating or bonded to gelatin particles through Schiff base reaction. The drug release experiments in vitro showed that about 10% of gentamicin was released within 0.5 h, the release lasted for 10 days, and the release from the composite coating was dependent on the pH value. The composite coating could induce the formation of apatite on the coating surface, which was fully covered after 7 days immersing in SBF solution. In addition, Ti6Al4V plate with the composite coating had excellent antibacterial activity against Staphylococcus aureus. All of the results provided the possibility that this composite coating might be applied as a controlled release system to deliver the water soluble drug, and as a bioactive, biodegradable layer on the bio-inert implant surface to induce the formation of apatite and actively bond to the surrounding tissue in vivo.
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Affiliation(s)
- Junwu Xiao
- Key Laboratory of Inorganic Coating Materials, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China, 200050
| | - Yingchun Zhu
- Key Laboratory of Inorganic Coating Materials, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China, 200050
| | - Yanyan Liu
- Key Laboratory of Inorganic Coating Materials, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China, 200050
| | - Yi Zeng
- Key Laboratory of Inorganic Coating Materials, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China, 200050
| | - Fangfang Xu
- Key Laboratory of Inorganic Coating Materials, Shanghai Institute of Ceramics, Chinese Academy of Sciences, Shanghai, China, 200050
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181
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Cai XZ, Jin AD, Yan SG. Did local teicoplanin delivery systems inhibit or aggravate implant-related infection? INTERNATIONAL ORTHOPAEDICS 2009; 34:453-4; author reply 455. [PMID: 19536540 DOI: 10.1007/s00264-009-0830-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 06/02/2009] [Indexed: 11/26/2022]
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182
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Moojen DJF, Vogely HC, Fleer A, Nikkels PGJ, Higham PA, Verbout AJ, Castelein RM, Dhert WJA. Prophylaxis of infection and effects on osseointegration using a tobramycin-periapatite coating on titanium implants--an experimental study in the rabbit. J Orthop Res 2009; 27:710-6. [PMID: 19025776 DOI: 10.1002/jor.20808] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
No options are available for local antibiotic delivery from uncemented implants. By loading a porous titanium implant with a biomimetic HA-coating (PeriApatite, PA) with antibiotics, we could obtain adequate local antibiotic concentrations and reduce infection susceptibility. This study investigated the efficacy of a tobramycin-loaded PA-coated titanium foam implant in preventing infection, as well as the effects on osseointegration. In 72 New Zealand White rabbits, an uncoated (Ti), PA-coated (PA), or Tobramycin-PA-coated (PA-tobra) titanium foam rod was implanted intramedullary in the left tibiae after contamination of the implant bed with none (control), 10(3), 10(4) or 10(5) CFU Staphylococcus aureus. PA-tobra implants were loaded with 2.4 mg tobramycin. After 28 days analysis was done by bacteriology, histopathology and histomorphometry. Six percent of the contaminated PA-tobra rabbits were infected, whereas this was 53 and 67% for PA and Ti, respectively (p < 0.001). Quantitative cultures were also significantly lower in the PA-tobra group (p = 0.003). None of the control rabbits were infected. Histopathological and histomorphometrical scores were both better for the PA-tobra group, although only significant compared to Ti. No significant differences were observed between PA and Ti rabbits. We conclude that the application of tobramycin to PA-coated titanium foam implants appears to be an effective local antibiotic strategy for uncemented implants for infection prophylaxis and has a beneficial effect on implant fixation, which will result in improved long-term implant survival.
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Affiliation(s)
- Dirk Jan F Moojen
- Department of Orthopaedics, University Medical Center Utrecht, Room G05.228, P.O. Box 85500, Heidelberglaan 100, 3484CX Utrecht, The Netherlands.
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Varoga D, Tohidnezhad M, Paulsen F, Wruck CJ, Brandenburg L, Mentlein R, Lippross S, Hassenpflug J, Besch L, Müller M, Jürgens C, Seekamp A, Schmitt L, Pufe T. The role of human beta-defensin-2 in bone. J Anat 2009; 213:749-57. [PMID: 19094191 DOI: 10.1111/j.1469-7580.2008.00992.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Osteomyelitis often causes functional impairment due to tissue destruction. This report demonstrates a novel previously unappreciated role of osteoblasts. Samples of osteomyelitic bone and bacterially challenged osteoblasts produce increased amounts of antimicrobial peptides in order to combat bacterial bone infection. An osteomyelitis mouse model confirmed the osseous induction of the murine homologue of human beta-defensin-2, suggesting a central role in the prevention of bacterial bone infection. Antimicrobial peptides are effectors of the innate defence system and play a key role in host protection at cellular surfaces. Some of them are produced constitutively, whereas others are induced during infection. Human beta-defensins represent a major subclass of antimicrobial peptides and act as a first line of defence through their broad spectrum of potent antimicrobial activity. The aim of the present in-vitro and in-vivo investigations was to study the expression and regulation of human beta-defensin-2 in the case of bacterial bone infection and to analyse the effects of immunosuppressive drugs on bone-derived antimicrobial peptide expression. Samples of healthy human bone, osteomyelitic bone and cultured osteoblasts (hFOB cells) were assessed for the expression of human beta-defensin-2. Regulation of human beta-defensin-2 was studied in hFOB cells after exposure to bacterial supernatants, proinflammatory cytokines and immunosuppressive drugs (glucocorticoids and methotrexate) and was assayed by enzyme-linked immunosorbent assay. An osteomyelitis mouse model was performed to demonstrate the regulation of the murine homologue of human beta-defensin-2, named murine beta-defensin-3, by real-time reverse transcription-polymerase chain reaction and immunohistochemistry. Healthy human bone and cultured osteoblasts are able to produce human beta-defensin-2 under standard conditions. Samples of infected bone produce higher levels of endogenous antibiotics, such as human beta-defensin-2, when compared with samples of healthy bone. A clear induction of human beta-defensin-2 was observed after exposure of cultured osteoblasts to gram-positive bacteria or proinflammatory cytokines. Additional treatment with glucocorticoids or methotrexate prevented bacteria-mediated antimicrobial peptide induction in cultured osteoblasts. The osteomyelitis mouse model demonstrated transcriptional upregulation of the murine homologue of human beta-defensin-2, namely murine beta-defensin-3, in bone after intraosseous contamination of the tibia. Human and murine bone have the ability to produce broad-spectrum endogenous antibiotics when challenged by micro-organisms in vitro and in vivo. Immunosuppressive drugs, such as glucocorticoids or methotrexate, may increase the susceptibility to bone infection by decreasing antimicrobial peptide expression levels in case of microbial challenge. The induction of human beta-defensin-2 following bacterial contact suggests a central role of antimicrobial peptides in the prevention of bacterial bone infection.
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Affiliation(s)
- D Varoga
- Department of Trauma Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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184
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Xiao J, Zhu Y, Liu Y, Zeng Y, Xu F. An asymmetric coating composed of gelatin and hydroxyapatite for the delivery of water insoluble drug. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2009; 20:889-896. [PMID: 19020957 DOI: 10.1007/s10856-008-3631-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 10/16/2008] [Indexed: 05/27/2023]
Abstract
An asymmetric coating composed of gelatin and hydroxyapatite on Ti6Al4V alloy implant was prepared to control the release of water-insoluble drug ibuprofen and improve the surface properties of the implant. The asymmetric coating developed into a thin dense outer layer and a thick porous inner layer using a dip-coating method and a succedent phase-inversion process. The drug loading ranged from 10 to 30% (w/w), and depended on the immersion time and drug concentration in the quenching solution. The in vitro release from this system was always at an approximately zero-order rate and at least lasted for 30 days. The in vitro studies in SBF revealed that the coating could induce the formation of apatite, and was fully covered after 14 days soaking in SBF solution. This asymmetric coating had better bioactivity of inducing the formation of apatite in vitro, compared with pure gelatin coating and bare Ti6Al4V implant.
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Affiliation(s)
- Junwu Xiao
- Shanghai Institute of Ceramics, Chinese Academy of Science, Shanghai, 200050, China
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185
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Treatment of long bone osteomyelitis with a mechanically stable intramedullar antibiotic dispenser: nineteen consecutive cases with a minimum of 12 months follow-up. ACTA ACUST UNITED AC 2009; 65:1416-20. [PMID: 19077636 DOI: 10.1097/ta.0b013e31818c6a09] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antibiotic cement beads are the most common system of local antibiotic delivery. Unfortunately, bead strings do not give mechanical support to the fracture site, stability being fundamental in osteomyelitis treatment. Local treatment associated with bone stability should improve the results in posttraumatic osteomyelitis. The objective of this article is to present our experience in the treatment of long bone osteomyelitis using an intramedullary, mechanically stable antibiotic dispenser. METHOD We present a retrospective review of a consecutive series of patients with a long bone osteomyelitis treated using an intramedullary, mechanically stable antibiotic dispenser. The dispenser used with a T-95 chest tube filled with poly(methyl methacrylate) + antibiotic (vancomycin, gentamycin, or both, tobramycin or imipenem; depending on culture results) and with a metal center (Ender nail). RESULTS Fifteen patients were men and three were women, with an average age of 37 years (range, 18-52 years). In four cases, treatment involved the femur and in 15 the tibia. Positive cultures were obtained from each patient. Methicillin-resistant Staphylococcus aureus was isolated in 17 cases. The intramedullary dispenser was removed between 6 and 76 weeks after surgery. Success was defined as negative cultures after dispenser removal. Follow-up period was between 10 and 54 months. Negative cultures were obtained from intramedullary reaming after dispenser removal in all but one patient who could not finish treatment because of local intolerance to antibiotic treatment. None of the 17 patients presented an infection recurrence. CONCLUSION The combination of local antibiotic treatment with bone segment stability showed acceptable results in our short series of patients. Further investigation on locked intramedullary antibiotic dispensers providing improved stability will help us learn about this difficult clinical scenario.
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186
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Koseki H, Shiraishi K, Asahara T, Tsurumoto T, Shindo H, Baba K, Taoda H, Terasaki N. Photocatalytic bactericidal action of fluorescent light in a titanium dioxide particle mixture: an in vitro study. Biomed Res 2009; 30:189-92. [DOI: 10.2220/biomedres.30.189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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187
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Shiraishi K, Koseki H, Tsurumoto T, Baba K, Naito M, Nakayama K, Shindo H. Antibacterial metal implant with a TiO2
-conferred photocatalytic bactericidal effect against Staphylococcus aureus. SURF INTERFACE ANAL 2008. [DOI: 10.1002/sia.2965] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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188
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Varoga D, Wruck CJ, Tohidnezhad M, Brandenburg L, Paulsen F, Mentlein R, Seekamp A, Besch L, Pufe T. Osteoblasts participate in the innate immunity of the bone by producing human beta defensin-3. Histochem Cell Biol 2008; 131:207-18. [DOI: 10.1007/s00418-008-0522-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2008] [Indexed: 12/25/2022]
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189
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Brin YS, Golenser J, Mizrahi B, Maoz G, Domb AJ, Peddada S, Tuvia S, Nyska A, Nyska M. Treatment of osteomyelitis in rats by injection of degradable polymer releasing gentamicin. J Control Release 2008; 131:121-7. [PMID: 18692531 DOI: 10.1016/j.jconrel.2008.07.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 06/26/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
We evaluated the potential of an injectable degradable polymer-poly(sebacic-co-ricinoleic-ester-anhydride) containing gentamicin for the treatment of osteomyelitis. Osteomyelitis of both tibiae was induced in 13 female Fischer rats by injecting a suspension containing approximately 105 (CFU)/ml of S. aureus into the tibial medullar canal. Three weeks later both tibiae were X-rayed, drilled down the medullar canal, washed with 50 microl gentamicin solution (80 mg/2 ml) and then injected with 50 microl P(SA-RA)+gentamycin 20% w/v to the right tibia and 50 microl P(SA-RA) without gentamicin to the left tibia. After an additional 3 weeks, the rats were sacrificed, and radiographs of the tibiae were taken. Histopathological evaluation of the tibiae was done in a blinded manner. X-ray radiographs showed that all tibiae developed changes compatible with osteomyelitis in 3 weeks. Histological evaluation revealed significant differences between right and left tibiae in 10 rats. In the left tibia moderate intramedullary abscess formation occurred. In most treated tibiae typical changes included the absence (or minimal grade only) of abscesses. The treated group developed significantly less intramedullary abscesses; the p value was 0.028. Locally injected degradable polymer releasing gentamicin proved to be efficient histologically in the treatment of osteomyelitis.
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Affiliation(s)
- Yaron S Brin
- Department of Orthopaedic Surgery, Meir Medical Center, 48 Tchernichovsky Str., Kfar-Saba 44281, Israel.
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190
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Zilberman M, Shifrovitch Y, Aviv M, Hershkovitz M. Structured Drug-eluting Bioresorbable Films: Microstructure and Release Profile. J Biomater Appl 2008; 23:385-406. [DOI: 10.1177/0885328207088261] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bioresorbable drug-eluting films can be used in many biomedical applications. Examples for such applications include biodegradable medical support devices which combine mechanical support with drug release and antibiotic-eluting film coatings for prevention of bacterial infections associated with orthopedic implants or during gingival healing. In the current study, bioresorbable drug-loaded polymer films are prepared by solution processing. Two film structures are studied: A polymer film with large drug crystals located on its surface (A-type) and a polymer film with small drug particles and crystals distributed within the bulk (B-type). The basic mode of drug dispersion/location in the film (A or B-type) is found to be determined mainly by the process of film formation and depends mainly on the solvent evaporation rate, whereas the drug's hydrophilicity has a minor effect on this structuring process. Most release profiles from A-type films exhibit a burst effect of ~30% and a second release stage that occurs at an approximately constant rate and is determined mainly by the polymer weight loss rate. An extremely high burst release is exhibited only by a very hydrophilic drug. The matrix (monolithic) nature of the B-type film enables release profiles that are determined mainly by the host polymer's degradation profile, with a very low burst effect in most of the studied systems. In addition to the drug location/ dispersion in the film, the host polymer and drug type also strongly affect the drug's release profile from the film. It has been demonstrated that appropriate selection of the process parameters and film components (polymer and drug) can yield film structures with desirable drug release behaviors. This can lead to the engineering of new bioresorbable drug-eluting film-based implants for various applications.
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Affiliation(s)
- M. Zilberman
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv 69978, Israel,
| | - Y. Shifrovitch
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv 69978, Israel
| | - M. Aviv
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv 69978, Israel
| | - M. Hershkovitz
- Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University, Tel Aviv 69978, Israel
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191
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Chuang HF, Smith RC, Hammond PT. Polyelectrolyte Multilayers for Tunable Release of Antibiotics. Biomacromolecules 2008; 9:1660-8. [DOI: 10.1021/bm800185h] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Helen F. Chuang
- Department of Chemical Engineering and Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Reneé C. Smith
- Department of Chemical Engineering and Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
| | - Paula T. Hammond
- Department of Chemical Engineering and Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139
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192
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Alvarez H, Castro C, Moujir L, Perera A, Delgado A, Soriano I, Evora C, Sánchez E. Efficacy of ciprofloxacin implants in treating experimental osteomyelitis. J Biomed Mater Res B Appl Biomater 2008; 85:93-104. [PMID: 17696153 DOI: 10.1002/jbm.b.30921] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ciprofloxacin (CFX) implants containing poly(D,L-lactide) and calcium phosphates (tricalcium phosphate and hydroxyapatite) was evaluated in 50 rabbits in an experimental osteomyelitis model. Their femoral cavity was inoculated with Staphylococcus aureus. After 2 weeks, the infected focus was cleaned out and the delivery system implanted. The infection and subsequent response to treatment were evaluated by microbiological analysis, biochemical and hematological markers, body weight, temperature, clinical signs, X-rays, and histology. Infected bone cultures, treated with CFX implants, showed reduced bacterial growth against controls. All CFX was released within 6 weeks. All animals recovered within 4 weeks. Even 12 weeks after implantation, no recurrence of infection was observed. Serum C-reactive protein, platelet, and leukocyte levels increased in all animals before treatment, and 4 weeks after it were maintained or rose in control animals, while decreased to normal levels in treated ones. Body weight was characterized by pretreatment losses, then gains during recuperation, or further loss in untreated animals; with no significant intraindividual differences in body temperature. Body weight, leucocytes, platelets, and C-reactive protein turned out to be highly useful markers for monitoring this kind of infection and its treatment. CFX implants demonstrated to be an effective therapy for S. aureus bone infection. Their efficacy was also reflected in decreasing severity of clinical signs, nonprogress of radiological signs indicative of infection, and good integration into bone structure. Histological examination revealed repair, with new bone formation extending into implants.
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Affiliation(s)
- H Alvarez
- Traumatology Service, Hospitén Rambla, Tenerife, Spain
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193
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Aviv M, Berdicevsky I, Zilberman M. Gentamicin-loaded bioresorbable films for prevention of bacterial infections associated with orthopedic implants. J Biomed Mater Res A 2007; 83:10-9. [PMID: 17340599 DOI: 10.1002/jbm.a.31184] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adhesion of bacteria to biomaterials and the ability of many microorganisms to form biofilms on foreign bodies are well-established as major contributors to the pathogenesis of implant-associated infections. Treatment of bone infection remains problematic, due to the difficulty of systemically administered antibiotics to locally penetrate bone. The current research addresses this issue by focusing on the development and study of novel gentamicin-loaded bioresorbable films designed to serve as "coatings" for fracture fixation devices and prevent implant-associated infections. Poly(L-lactic acid) and poly (D,L-lactic-co-glycolic acid) films containing gentamicin were developed through solution processing. The effects of polymer type, drug content, and processing conditions on the drug release profile were studied with respect to film morphology. The examined films generally exhibited a burst effect followed by a moderate approximately constant rate of release. The drug contents in the surrounding medium exceeded the required minimal effective concentration. Various gentamicin concentrations that were released from the films with time exhibited efficacy against bacterial species known to be involved in orthopedic infections. The developed systems can be applied on the surface of any metallic or polymeric fracture fixation device, and may therefore comprise a significant contribution to the field of orthopedic implants.
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Affiliation(s)
- Moran Aviv
- Department of Biomedical Engineering, Tel-Aviv University, Tel-Aviv 69978, Israel
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194
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Hupcey MAZ, Ekins S. Improving the drug selection and development process for combination devices. Drug Discov Today 2007; 12:844-52. [PMID: 17933686 DOI: 10.1016/j.drudis.2007.07.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 07/14/2007] [Accepted: 07/16/2007] [Indexed: 11/16/2022]
Abstract
Combination devices are at the interface of both pharmaceutical and medical device research. While there have been several notable successes in bringing combination devices to market there are drug selection criteria that both the pharmaceutical and medical device companies need to consider. A successful combination device creates a product that has efficacy greater than the sum of the parts. However, failure to address some aspects of the drug or biologic properties in enough detail could result in a suboptimal product, creating a challenging legacy for future iterations. This review addresses the many dimensions including opportunities and challenges of combination device development from both the device and pharmaceutical perspectives.
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Affiliation(s)
- Maggie A Z Hupcey
- PA Consulting Group, 600 College Road East, Suite 1120, Princeton, NJ 08540, USA.
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195
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Antoci V, Adams CS, Hickok NJ, Shapiro IM, Parvizi J. Vancomycin bound to Ti rods reduces periprosthetic infection: preliminary study. Clin Orthop Relat Res 2007; 461:88-95. [PMID: 17549034 DOI: 10.1097/blo.0b013e318073c2b2] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A major challenge in treating periprosthetic infection is the predilection of certain bacteria to colonize implants, form biofilms, and resist treatment. We engineered an innovative self-protective implant with covalently bound antibiotics that prevents bacterial colonization and remains stable for extended periods of time. To test this surface in vivo, we developed a rat periprosthetic infection model with an intramedullary implant in S. aureus-infected femora. Using the model, we then evaluated the effect of vancomycin-modified titanium rods on the clinical presentation of bone infection. Finally, assuming delayed and chronic periprosthetic infections originate from biofilms atop contaminated implants, the numbers of surface adherent bacteria were measured to assess the capability of the implant to prevent biofilms. S. aureus (1.5 x 10(3) colony forming units) with no known resistance were injected into the femoral canal of Wistar rats, followed by the implant. Signs of infection were assessed weekly by direct clinical observation of the animals, radiograph, and microCT, and counts of bacteria adherent to the implant. Vancomycin-modified implants showed superior inhibition of bacterial attachment and proliferation compared to control titanium surfaces.
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Affiliation(s)
- Valentin Antoci
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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196
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Ofluoglu EA, Zileli M, Aydin D, Baris YS, Kuçukbasmaci O, Gonullu N, Ofluoglu O, Toplamaoglu H. Implant-related infection model in rat spine. Arch Orthop Trauma Surg 2007; 127:391-6. [PMID: 17522873 DOI: 10.1007/s00402-007-0365-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The rate of postoperative infections is approximately 1% in spine surgery. However, when metal implants are used, postoperative infection rates significantly increase and were reported between 2.1 and 8.5%. This study aim to set up an infection model in the rat spine with a metal implant. MATERIALS AND METHODS Forty white male Sprague Dawley rats were randomly divided in four groups. In all rats, under operation microscope, a 3 mm titanium microscrew was implanted in the thoracolumbar area (T10-L1) after laminar decortication. In Group I (control group), sterile isotonic solution and in other three groups, different concentrations of Staphylococcus aureus [Group II: (10(2)), Group III: (10(3)), Group IV: (10(6))] were squirted on the decorticated lamina site. All animals were sacrificed after 2 weeks, and then blood cultures and cultures from fascia, muscle and bone were obtained. Bacterial number in each tissue was measured as colony-forming unit per gram tissue. Titanium microscrews were placed in 0.5 ml tryptic soy broth and vortexed than plated on trypticase soy agar to determine bacterial growth. Two animals from each group were subjected to histological examination. RESULTS Blood cultures obtained by intra-atrial puncture after 2 weeks were negative in all groups indicating no systemical infection developed. Bacterial cultures were negative in all specimens of Group I (control group). A significant osseous infection was confirmed in Groups II, III and IV. Comparison of bacterial counts in bone cultures showed no significant difference between Group III (10(3) CFU/10 microl) and Group IV (10(6) CFU/10 microl) (P > 0.05), while both groups had significantly higher counts than Group II (10(2) CFU/10 microl) (P > 0.05). Microscopic findings of supurrative inflammation were present only in Group IV (10(6) CFU/10 microl). CONCLUSIONS This study shows that inoculation of S. aureus in 10(6) CFU/10 microl concentration at the decorticated lamina after implantation of a titanium screw in rat spine is a reproducible model for spinal infection and can be used for the animal model of prophylaxis and treatment and of postoperative infection.
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Affiliation(s)
- Ender Ali Ofluoglu
- Department of Neurosurgery, Bakirkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.
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197
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Harris LG, Meredith DO, Eschbach L, Richards RG. Staphylococcus aureus adhesion to standard micro-rough and electropolished implant materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2007; 18:1151-6. [PMID: 17268867 DOI: 10.1007/s10856-007-0143-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2005] [Accepted: 03/29/2006] [Indexed: 05/13/2023]
Abstract
Implant-associated infections can cause serious complications including osteomyelitis and soft tissue damage, and are a great problem due to the emergence of antibiotic resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA). In some cases, antibiotic-loaded beads which release the antibiotic locally have been used, however such systems may lead to the development of antibiotic-resistant bacteria, as seen with gentamicin-loaded beads. Hence modifying the actual metal implant surface to inhibit or reduce initial bacterial adhesion may be an alternative option. This study describes the visualisation and quantification of S. aureus adhering to standard micro-rough 'commercially pure' titanium (TS) and Ti-6Al-7Nb (NS) surfaces, electropolished titanium (TE) and Ti-6Al-7Nb (NE) surfaces, and standard electropolished stainless steel (SS). Qualitative and quantitative results of S. aureus on the different surfaces correlated with each other, and showed significantly more live bacteria on NS than on the other surfaces, whilst there was no significant difference between the amount of bacteria on TS, TE, NE and SS surfaces. The results showed a significant decrease in the amount of bacteria adhering to the NE compared to standard NS surfaces. Such an observation suggests that the NS surface encouraged S. aureus adhesion, and could lead to higher infection rates in vivo. Hence electropolishing Ti-6Al-7Nb surfaces could be advantageous in osteosynthesis areas in minimising bacterial adhesion and lowering the rate of infection.
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Affiliation(s)
- Llinos G Harris
- AO Research Institute, AO Foundation, Clavadelerstrasse 8, 7270 Davos, Switzerland.
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198
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Bahna P, Dvorak T, Hanna H, Yasko AW, Hachem R, Raad I. Orthopaedic metal devices coated with a novel antiseptic dye for the prevention of bacterial infections. Int J Antimicrob Agents 2007; 29:593-6. [PMID: 17317111 DOI: 10.1016/j.ijantimicag.2006.12.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2006] [Revised: 12/15/2006] [Accepted: 12/18/2006] [Indexed: 10/23/2022]
Abstract
Gendine is a novel antiseptic dye with broad-spectrum antimicrobial activity that may be used to coat plastics and metal devices. Our objective was to determine the efficacy of gendine-coated orthopaedic metal devices in preventing methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Stainless steel and titanium Schanz rods were coated with gendine. The zone of inhibition (ZoI) around the rods with and without gamma-irradiation was determined by a modified Kirby-Bauer method. A previously published bioprosthetic biofilm colonisation model, modified Kuhn's method, was used to determine the adherence of MRSA to coated and uncoated rods, with and without irradiation, after insertion into bovine bone and after 3 months shelf life followed by 2 weeks of immersion in serum. The gendine-coated Schanz metal rods showed a net ZoI of 16 mm against MRSA before and after irradiation. Gendine-coated rods showed no biofilm formation (0 colony-forming units (CFU)), which was a significant reduction (P<0.001) compared with uncoated controls (>5000 CFU). Coated rods exposed to high-dose gamma-irradiation and coated rods drilled into bone also showed significant efficacy (P<0.001) in preventing biofilm adherence. After 2 weeks, gendine-coated rods maintained significant durability (P<0.01), resulting in 90% reduction in MRSA biofilm adherence compared with uncoated control rods. Results indicate that gendine-coated metal rods are highly efficacious in the prevention of MRSA biofilm.
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Affiliation(s)
- Paul Bahna
- Department of Infectious Diseases, Infection Control and Employee Health (Unit 402), The University of Texas M D Anderson Cancer Center, PO Box 301402, Houston, TX 77230-1402, USA
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199
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Fuchs T, Schmidmaier G, Raschke MJ, Stange R. Bioactive-Coated Implants in Trauma Surgery. Eur J Trauma Emerg Surg 2007; 34:60-8. [DOI: 10.1007/s00068-006-6110-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 06/27/2006] [Indexed: 10/23/2022]
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200
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Kuhn S, Hansen M, Rommens PM. Extending the Indication of Intramedullary Nailing of Tibial Fractures. Eur J Trauma Emerg Surg 2007; 33:159-69. [PMID: 26816146 DOI: 10.1007/s00068-007-7039-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Accepted: 02/28/2007] [Indexed: 11/27/2022]
Abstract
Intramedullary nailing is an effective and well-established method for the treatment of a wide spectrum of tibial fractures. Nevertheless, the handling of metaphyseal and open fracture remains challenging. Surgical and technical advancements have opened up new possibilities to broaden the indication of intramedullary nailing in these areas.
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Affiliation(s)
- Sebastian Kuhn
- Department of Trauma Surgery, University Hospital of the Johannes Gutenberg University of Mainz, Mainz, Germany. .,Department of Trauma Surgery, University Hospital of the Johannes Gutenberg University of Mainz, Langenbeckstrasse 1, 55101, Mainz, Germany.
| | - Matthias Hansen
- Department of Trauma Surgery, Hand, and Reconstructive Surgery, Academic Teaching Hospital of the University Mainz, Worms, Germany
| | - Pol M Rommens
- Department of Trauma Surgery, University Hospital of the Johannes Gutenberg University of Mainz, Mainz, Germany
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