1
|
Fölsch C, Preu S, Ulloa CF, Kühn K, Rickert M, Jahnke A. Palmitic acid coating of allogeneic cancellous bone for local antibiotic treatment: A porcine impaction bone grafting model. J Orthop 2023; 35:24-30. [PMID: 36345327 PMCID: PMC9636015 DOI: 10.1016/j.jor.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/23/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction The worldwide rising number of joint replacements results in increasing revision surgery including a relevant portion of septic loosening accompanied by bone deficiencies. Loading of allogeneic bone with antibiotics provides high local antibiotic concentrations and might eradicate bacteria which appear resistant to systemic antibiotic application. Hydrophobic palmitic acid was shown to be a suitable carrier for antibiotics and prevents biofilm. Methods Cancellous bone derived from 6 to 7 months old piglets was used for a standardized in vitro impaction bone grafting model according to previous studies. The specimens were either thermodisinfected or remained native and palmitic acid with one third and two third partial weight were added and compared with control. Shear force at the interface prosthesis to cement and between cement and bone was measured. The relative micromovements were measured with 6 inductive sensors with a resolution of 0.1 μm at three different measuring heights up to a maximum movement of 150 μm between cement and bone. Taking into account the corresponding applied torque the measured values were normalized in μm/Nm. Statistical analysis was done with SPSS Statistics® Version 26.0 IBM. Results Smallest movement was measured for thermodisinfected cancellous bone and a not significant decrease of shear force resistance with addition of palmitic acid was found since supplementing native cancellous bone reduced shear force resistance significantly depending on the weight percentage of palmitic acid. Conclusion Supplementation of porcine cancellous bone with palmitic acid did not significantly reduce shear force resistance of thermodisinfected bone since adding palmitic acid to native bone decreased it significantly depending on the volume added. Palmitic acid seems to be a suitable coating for allogeneic cancellous bone to deliver high local antibiotic concentrations and thermodisinfected cancellous bone might be able to store larger volumes of palmitic acid than native bone without relevant influence on shear force resistance.
Collapse
Affiliation(s)
- C. Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Gießen and Marburg (UKGM), Justus-Liebig-University, Klinikstraße 33, 35392, Gießen, Germany
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - S. Preu
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - C.A. Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - K.D. Kühn
- Department of Orthopaedics and Orthopaedic Surgery, Medical University Graz, Auenbruggerstraße 5, Graz, Austria
| | - M. Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Gießen and Marburg (UKGM), Justus-Liebig-University, Klinikstraße 33, 35392, Gießen, Germany
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| | - A. Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Gießen, Klinikstraße 29, 35392, Gießen, Germany
| |
Collapse
|
2
|
Fölsch C, Sahm P, Ulloa CAF, Krombach GA, Kampschulte M, Rickert M, Pruss A, Jahnke A. Effect of synthetic bone replacement material of different size on shear stress resistance within impacted native and thermodisinfected cancellous bone: an in vitro femoral impaction bone grafting model. Cell Tissue Bank 2021; 22:651-664. [PMID: 33893901 PMCID: PMC8558171 DOI: 10.1007/s10561-021-09924-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/03/2021] [Indexed: 11/06/2022]
Abstract
Antibiotic carrier particles of variable size might influence mechanic properties within impacted thermodisinfected and native cancellous bone different. Herafill®G containing calciumsulfate and calciumcarbonate provides high local concentrations of gentamicin being important for revision surgery in infected joint replacements. Native and thermodisinfected cancellous bone derived from 6 to 7 months old piglets was used for in vitro impaction bone grafting and supplemented each with Herafill®G granules of two different sizes. Micromovement of implants related to shear force was measured in 29 specimens distributed in 6 groups. Thermodisinfected cancellous bone revealed a significant higher shear force resistance than native bone with a mean difference of 423.8 mdeg/Nm (p < 0.001) ranging within 95% confidence interval from 181.5 to 666.0 mdeg/Nm. Adding small granules to thermodisinfected bone did not reduce shear force resistance significantly since adding large granules to native bone improved it by 344.0 mdeg/Nm (p < 0.003). Shear force resistance was found higher at the distal region of the implant compared to a proximal point of measurement throughout all specimens. Less impaction impulses were necessary for thermodisinfected bone. Thermodisinfected cancellous bone might achieve a higher degree of impaction compared with native bone resulting in increased resistance against shear force since impaction was found increased distally. Supplementation of thermodisinfected bone with small granules of Herafill®G might be considered for application of local antibiotics. Large granules appeared more beneficial for supplementation of native bone. Heterogeneity of bone graft and technical aspects of the impaction procedure have to be considered regarding the reproducibility of femoral impaction bone grafting.
Collapse
Affiliation(s)
- C Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Gießen, Germany.
| | - P Sahm
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - C A Fonseca Ulloa
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Rickert
- Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 33, 35392, Gießen, Germany
| | - A Pruss
- Institute of Transfusion Medicine, University Tissue Bank, Charité University Medical School, Charitéplatz 1, 10117, Berlin, Germany
| | - A Jahnke
- Laboratory of Biomechanics, Department of Orthopaedic Surgery, Justus-Liebig-University Medical School, Klinikstrasse 29, 35392, Giessen, Germany
| |
Collapse
|
3
|
Fölsch C, Bok J, Krombach GA, Rickert M, Ulloa CAF, Ahmed GA, Kampschulte M, Jahnke A. Influence of antibiotic pellets on pore size and shear stress resistance of impacted native and thermodisinfected cancellous bone: An in vitro femoral impaction bone grafting model. J Orthop 2020; 22:414-421. [PMID: 33029046 DOI: 10.1016/j.jor.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/13/2020] [Indexed: 10/23/2022] Open
Abstract
Introduction Morphology and mechanic properties of impacted cancellous bone are affected by carrier substances which provide high local concentrations of antibiotics. Methods Bone chips were taken from the femoral head of 6-7 months old piglets. One half was thermodisinfected and the other remained native. Ten specimens each were mixed with Herafill® antibiotic pellets and a control group of each 10 specimens respectively was examined. The cancellous bone was impacted according to Exeter technique and the implants were cemented. The distribution of the particles and the pores were defined with three dimensional computertomographic scan and shear force resistance was measured until failure. Results Shear force resistance was not measured significantly less for thermodisinfected (2.7 Nm) compared with native bone (3.5 Nm) and addition of antibiotic pellets reduced shear force resistance in both groups since this was significant for the native group. The average pore volume of the native bone specimens appeared significant smaller compared to the thermodisinfected group (p = 0.011) and the pore volume showed a negative correlation with shear force resistance (p = 0.044). Pore volume around the pellets was found significantly increased and it appeared smaller for native bone. The number of pellets located next to the implant showed a negative correlation with shear force resistance (p = 0.034) and the negative correlation increased for pellets below the tip of the shaft model (p = 0.024). Conclusion Adding antibiotic pellets to native and thermodisinfected impacted cancellous bone increased pore volume since the area around the pellets showed increased porosity which correlated with reduced shear force resistance. Computertomographic three dimensional measurement of porosity might predict shear force resistance of impacted cancellous bone and improve impaction of bone grafting intraoperatively.
Collapse
Affiliation(s)
- C Fölsch
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - J Bok
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Krombach
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - M Rickert
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - C A Fonseca Ulloa
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - G A Ahmed
- Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Justus-Liebig-University, Klinikstrasse 33, 35392 Giessen, Germany.,Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| | - M Kampschulte
- Department of Diagnostic and Interventional Radiology, Laboratory for Experimental Radiology, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392, Giessen, Germany
| | - A Jahnke
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, Germany
| |
Collapse
|