1
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Ge H, Yan H, Liu X, Huang Y, Zeng J. Finite element analysis of the mechanical strength of a new hip Spacer. BMC Musculoskelet Disord 2023; 24:434. [PMID: 37254116 DOI: 10.1186/s12891-023-06562-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/20/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVE At present, the influence of the internal metallic endoskeleton of Spacer on the biomechanical strength of Spacer remains unclear. The aim of this study was to analyze the mechanical stability of a novel Spacer applying a annular skeleton that mimics the structure of trabecular bone using finite element methods. METHEDS The femur models of three healthy individuals and skeletonless Spacer, K-Spacer, and AD-Spacer were assembled to create 15 3D models. Finite element analysis was performed in an Ansys Bench2022R1. Biomechanical parameters such as stress and strain of the Spacer, internal skeleton and femur were evaluated under three loads, which were applied with the maximum force borne by the hip joint (2100 N), standing on one leg (700 N), and standing on two legs (350 N). The mechanical properties of the new hip Spacer were evaluated. RESULT The stresses on the medial and lateral surfaces of the AD-Spacer and K-Spacer were smaller than the stresses in the state without skeletal support. The maximum stresses on the medial and lateral surfaces of the AD-Spacer were smaller than those of the inserted K-Spacer, and the difference gradually increased with the increase of force intensity. When the skeleton diameter was increased from 3 to 4 mm, the stresses in the medial and lateral sides of the AD-Spacer and K-Spacer necks decreased. The stress of both skeletons was concentrated at the neck, but the stress of the annular skeleton was evenly distributed on the medial and lateral sides of the skeleton. The mean stress in the proximal femur was higher in femurs with K-Spacer than in femurs with AD-Spacer. CONCLUSIONS AD-Spacer has lower stress and higher load-bearing capacity than K-Spacer, and the advantages of AD-Spacer are more obvious under the maximum load state of hip joint.
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Affiliation(s)
- Hao Ge
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Hongsong Yan
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Xianwang Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Yiwei Huang
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District 22 Baiyun, Guangzhou, 510405, Guangdong, China.
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Sambri A, Fiore M, Rondinella C, Morante L, Paolucci A, Giannini C, Alfonso C, De Paolis M. Mechanical complications of hip spacers: a systematic review of the literature. Arch Orthop Trauma Surg 2023; 143:2341-2353. [PMID: 35414129 PMCID: PMC10110705 DOI: 10.1007/s00402-022-04427-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/17/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Temporary spacers used in the staged revision of a hip prosthetic joint infection (PJI) have been associated with several mechanical complications with very variable reported general complications rates up to 73%. The aim of this systematic review was to assess the mechanical complications associated with hip antibiotic-loaded spacers when treating periprosthetic hip PJI. METHODS Through an electronic systematic search of PubMed, articles reporting mechanical complications of spacers used in the treatment of hip PJI were reviewed. Dislocations, spacer fracture, femoral fractures, and acetabular lysis rates were evaluated. RESULTS Forty studies were included. Standardized molded spacers had a significantly higher weighted mean of total mechanical complication rates (37.2%) when compared to standardized preformed spacers (13.8%, p = 0.039), while no significant difference was found between molded spacers and manually shaped spacers. Spacer dislocation was the most frequent complication. No significant difference in mechanical complication rate was found between spacers with and without any metallic component. CONCLUSIONS Spacer placement in chronic PJI of the hip with bone and soft-tissue defects is challenging and bears a high risk of mechanical failures and progressive bone loss during the interim period. A careful patient selection for spacer implantation is mandatory.
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Affiliation(s)
- Andrea Sambri
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy.
- University of Bologna, Bologna, Italy.
| | | | | | | | | | | | - Calogero Alfonso
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - Massimiliano De Paolis
- IRCCS Azienda Ospedaliera Universitaria di Bologna, Via Massarenti 9, 40138, Bologna, Italy
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3
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Perez Alamino L, Garabano G, Rodriguez JA, Cullari M, Del Sel H, Pesciallo CA. Effectiveness of two-stage revision with commercial polymethylmethacrylate articulated hip spacer: similar outcomes against monomicrobial and polymicrobial hip periprosthetic joint infections. J Bone Jt Infect 2023. [DOI: 10.5194/jbji-8-51-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract. Background: orthopaedic surgeons still struggle against a devastating complication – periprosthetic joint infection (PJI). A two-stage revision is
considered the gold standard for chronic PJI for several authors, with
success rates over 90 %. This strategy implies the remotion of the
prosthesis and the implantation of an antibiotic-impregnated cement spacer
in the joint. The primary objective of this study was to assess the
effectiveness of a two-stage revision approach using a commercial
prefabricated antibiotic-impregnated cement hip spacer for the treatment of
hip PJI regarding monomicrobial and polymicrobial infections. Secondly, to
assess risk factors for failure of two-stage revision. Material and methods:
we conducted a retrospective study on patients that underwent revision of
total hip arthroplasty (THA) between January 2002 and January 20218. We included adult patients with a diagnosis of chronic hip PJI that underwent two-stage revision using a
prefabricated gentamicin-impregnated cement of polymethylmethacrylate (PMMA)
hip spacer. We assessed whether it was monomicrobial or polymicrobial infections and comorbidities. Treatment success was defined when eradication of the
infection was observed and no further procedures or mortality were
registered after the second stage. Persistence or recurrence of infection
was considered a failure of treatment. Results: the final series consisted
of 84 patients treated with the same hip spacer: 60 (71.4 %) monomicrobial
and 24 (28.6 %) polymicrobial joint infections with an overall follow-up
of 59.0 (36.0–84.0) months. The overall success rate was 90.5 %. Eight
(9.5 %) patients failed. Smoking and BMI greater than 30 m kg−2 were
identified independent risk factors for failure in multivariate analysis.
Conclusion: our study suggests that prefabricated gentamicin-impregnated
PMMA spacer is an effective tool for the treatment of PJI, achieving similar
outcomes whether it is monomicrobial or polymicrobial infections. Randomized prospective studies are needed to obtain more reliable conclusions.
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Sobornova VV, Belov KV, Dyshin AA, Gurina DL, Khodov IA, Kiselev MG. Molecular Dynamics and Nuclear Magnetic Resonance Studies of Supercritical CO 2 Sorption in Poly(Methyl Methacrylate). Polymers (Basel) 2022; 14:polym14235332. [PMID: 36501726 PMCID: PMC9737377 DOI: 10.3390/polym14235332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
The study of supercritical carbon dioxide sorption processes is an important and urgent task in the field of "green" chemistry and for the selection of conditions for new polymer material formation. However, at the moment, the research of these processes is very limited, and it is necessary to select the methodology for each polymer material separately. In this paper, the principal possibility to study the powder sorption processes using 13C nuclear magnetic resonance spectroscopy, relaxation-relaxation correlation spectroscopy and molecular dynamic modeling methods will be demonstrated based on the example of polymethylmethacrylate and supercritical carbon dioxide. It was found that in the first nanoseconds and seconds during the sorption process, most of the carbon dioxide, about 75%, is sorbed into polymethylmethacrylate, while on the clock scale the remaining 25% is sorbed. The methodology presented in this paper makes it possible to select optimal conditions for technological processes associated with the production of new polymer materials based on supercritical fluids.
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Robu A, Antoniac A, Ciocoiu R, Grosu E, Rau JV, Fosca M, Krasnyuk II, Pircalabioru GG, Manescu (Paltanea) V, Antoniac I, Gradinaru S. Effect of the Antimicrobial Agents Peppermint Essential Oil and Silver Nanoparticles on Bone Cement Properties. Biomimetics (Basel) 2022; 7:biomimetics7030137. [PMID: 36134941 PMCID: PMC9496347 DOI: 10.3390/biomimetics7030137] [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: 08/10/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022] Open
Abstract
The main problems directly linked with the use of PMMA bone cements in orthopedic surgery are the improper mechanical bond between cement and bone and the absence of antimicrobial properties. Recently, more research has been devoted to new bone cement with antimicrobial properties using mainly antibiotics or other innovative materials with antimicrobial properties. In this paper, we developed modified PMMA bone cement with antimicrobial properties proposing some experimental antimicrobial agents consisting of silver nanoparticles incorporated in ceramic glass and hydroxyapatite impregnated with peppermint oil. The impact of the addition of antimicrobial agents on the structure, mechanical properties, and biocompatibility of new PMMA bone cements was quantified. It has been shown that the addition of antimicrobial agents improves the flexural strength of the traditional PMMA bone cement, while the yield strength values show a decrease, most likely because this agent acts as a discontinuity inside the material rather than as a reinforcing agent. In the case of all samples, the addition of antimicrobial agents had no significant influence on the thermal stability. The new PMMA bone cement showed good biocompatibility and the possibility of osteoblast proliferation (MTT test) along with a low level of cytotoxicity (LDH test).
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Affiliation(s)
- Alina Robu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Robert Ciocoiu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Elena Grosu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
| | - Julietta V. Rau
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere, 100, 00133 Rome, Italy
- Institute of Pharmacy, Department of Analytical, Physical and Colloid Chemistry, I.M. Sechenov First Moscow State Medical University, Trubetskaya 8, Build. 2, 119991 Moscow, Russia
| | - Marco Fosca
- Istituto di Struttura della Materia, Consiglio Nazionale delle Ricerche (ISM-CNR), Via del Fosso del Cavaliere, 100, 00133 Rome, Italy
| | - Ivan I. Krasnyuk
- Institute of Pharmacy, Department of Analytical, Physical and Colloid Chemistry, I.M. Sechenov First Moscow State Medical University, Trubetskaya 8, Build. 2, 119991 Moscow, Russia
| | - Gratiela Gradisteanu Pircalabioru
- Research Institute of the University of Bucharest, University of Bucharest, 90 Soseaua, Panduri, 050663 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, District 5, 050094 Bucharest, Romania
| | - Veronica Manescu (Paltanea)
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, 060042 Bucharest, Romania
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, District 6, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, District 5, 050094 Bucharest, Romania
- Correspondence:
| | - Sebastian Gradinaru
- Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania
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Szabelski J, Karpiński R, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5577. [PMID: 36013714 PMCID: PMC9416016 DOI: 10.3390/ma15165577] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.
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Affiliation(s)
- Jakub Szabelski
- Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Przemysław Krakowski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
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Kugelman D, Roof M, Egol A, Guanche I, Chen AF, Schwarzkopf R, Aggarwal VK. Comparing Articulating Spacers for Periprosthetic Joint Infection After Primary Total Hip Arthroplasty: All-Cement Versus Real-Component Articulating Spacers. J Arthroplasty 2022; 37:S657-S663. [PMID: 35210152 DOI: 10.1016/j.arth.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/30/2021] [Accepted: 12/09/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are a variety of methods available to treat periprosthetic joint infection (PJI), including 2-stage revision with the use of an antibiotic spacer. This study compares the outcomes of real-component (RC) and all-cement (AC) articulating spacers for total hip arthroplasty (THA) PJI treatment. METHODS This multicenter retrospective study assessed all articulating spacers placed for THA PJI between April 2011 and August 2020. Patients were dichotomized based on spacer type (RC vs AC). RESULTS One hundred four patients received articulating spacer constructs (RC group = 75, AC group = 29). Leg-length discrepancy was significantly greater in the AC group after the second stage (3.58 vs 12.00 mm, P = .023). There were no significant differences in reoperation rates following first-stage spacer placement (P = .752) and time to reimplantation (P = .127) between the groups. There were no significant differences in reinfection rates (RC group = 10.0%, AC group = 7.1%, P = 1.000) and reoperation rates following second-stage revision THA (RC group = 11.7%, AC group = 10.7%, P = 1.000). Hospital length of stay (in days) had a trend toward being shorter following the first (7.35 vs 11.96, P = .166) and second stage (3.95 vs 5.43, P = .107) for patients in the RC group. Patients in the RC group were more likely to be discharged home following the first (P = .020) and second (P = .039) stages. CONCLUSION Given that there were no differences in reinfection and reoperation rates between the 2 spacer constructs, RC articulating spacers may provide a significant benefit for patient comfort during 2-stage exchange treatment of PJI while adding no increase in risk profile.
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8
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Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of joint aspiration before re-implantation in patients with a cement spacer in place. World J Orthop 2022; 13:615-621. [PMID: 35949711 PMCID: PMC9244963 DOI: 10.5312/wjo.v13.i6.615] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/04/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The usefulness of a mandatory joint aspiration before re-implantation in patients with a cement spacer already in place is unclear.
AIM To evaluate the role of culturing synovial fluid obtained by joint aspiration before re-implantation in patients who underwent a two-stage septic revision.
METHODS A retrospective observational study was conducted, including patients that underwent a two-stage septic revision (hip or knee) from 2010 to 2017. After the first stage revision and according to intraoperative culture results, all patients were treated with an antibiotic protocol for 6-8 wk. Following 2 wk without antibiotics, a culture of synovial fluid was obtained. The results of these cultures were recorded and compared with cultures obtained during re-implantation surgery.
RESULTS Forty-one patients (20 hip and 21 knee spacers) were included in the final analysis. In 39 cases, the culture of synovial fluid was negative, while in the remaining 2 cases (knee spacers) no analysis was possible due to dry tap. In 5 of the patients, two or more intraoperative cultures taken during the re-implantation surgery were positive.
CONCLUSION We found no evidence to support mandatory joint aspiration before re-implantation in patients with a cement spacer in place.
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Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l’Alt Penedès - Garraf, Vilafranca del Penedès 08720, Spain
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
- Department of Microbiology, CATLAB, Viladecavalls 08232, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Osteoarticular Infections Unit, Hospital Clínic, Barcelona 08036, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Terrassa 08221, Spain
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Mordovina EA, Plastun VO, Abdurashitov AS, Proshin PI, Raikova SV, Bratashov DN, Inozemtseva OA, Goryacheva IY, Sukhorukov GB, Sindeeva OA. "Smart" Polylactic Acid Films with Ceftriaxone Loaded Microchamber Arrays for Personalized Antibiotic Therapy. Pharmaceutics 2021; 14:pharmaceutics14010042. [PMID: 35056938 PMCID: PMC8781070 DOI: 10.3390/pharmaceutics14010042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 11/24/2022] Open
Abstract
Bacterial infections are a severe medical problem, especially in traumatology, orthopedics, and surgery. The local use of antibiotics-elution materials has made it possible to increase the effectiveness of acute infections treatment. However, the infection prevention problem remains unresolved. Here, we demonstrate the fabrication of polylactic acid (PLA) “smart” films with microchamber arrays. These microchambers contain ceftriaxone as a payload in concentrations ranging from 12 ± 1 μg/cm2 to 38 ± 8 μg/cm2, depending on the patterned film thickness formed by the different PLA concentrations in chloroform. In addition, the release profile of the antibiotic can be prolonged up to 72 h in saline. At the same time, on the surface of agar plates, the antibiotic release time increases up to 96 h, which has been confirmed by the growth suppression of the Staphylococcus aureus bacteria. The efficient loading and optimal release rate are obtained for patterned films formed by the 1.5 wt % PLA in chloroform. The films produced from 1.5 and 2 wt % PLA solutions (thickness—0.42 ± 0.12 and 0.68 ± 0.16 µm, respectively) show an accelerated ceftriaxone release upon the trigger of the therapeutic ultrasound, which impacted as an expansion of the bacterial growth inhibition zone around the samples. Combining prolonged drug elution with the on-demand release ability of large cargo amount opens up new approaches for personalized and custom-tunable antibacterial therapy.
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Affiliation(s)
- Ekaterina A. Mordovina
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (V.O.P.); (D.N.B.); (O.A.I.); (I.Y.G.)
- Correspondence: (E.A.M.); (O.A.S.)
| | - Valentina O. Plastun
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (V.O.P.); (D.N.B.); (O.A.I.); (I.Y.G.)
| | - Arkady S. Abdurashitov
- Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia; (A.S.A.); (P.I.P.); (G.B.S.)
| | - Pavel I. Proshin
- Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia; (A.S.A.); (P.I.P.); (G.B.S.)
| | - Svetlana V. Raikova
- Saratov Hygiene Medical Research Center of the FBSI «FSC Medical and Preventive Health Risk Management Technologies», 1A Zarechnaya Str., 410022 Saratov, Russia;
- Department of Microbiology, Virology, and Immunology, Saratov State Medical University, 112 Bolshaya Kazachia Str., 410012 Saratov, Russia
| | - Daniil N. Bratashov
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (V.O.P.); (D.N.B.); (O.A.I.); (I.Y.G.)
| | - Olga A. Inozemtseva
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (V.O.P.); (D.N.B.); (O.A.I.); (I.Y.G.)
| | - Irina Yu. Goryacheva
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (V.O.P.); (D.N.B.); (O.A.I.); (I.Y.G.)
| | - Gleb B. Sukhorukov
- Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia; (A.S.A.); (P.I.P.); (G.B.S.)
- School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK
| | - Olga A. Sindeeva
- Center for Neurobiology and Brain Restoration, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia; (A.S.A.); (P.I.P.); (G.B.S.)
- Correspondence: (E.A.M.); (O.A.S.)
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10
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Huguet S, Bernaus M, Gómez L, Cuchí E, Soriano A, Font-Vizcarra L. Role of bacterial colonisation of vancomycin-gentamicin spacers in two-stage arthroplasty revision surgery: the usefulness of spacer sonication. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1661-1669. [PMID: 34677662 DOI: 10.1007/s00590-021-03151-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE In two-stage replacements for septic loosening, some studies have suggested an association between bacterial colonisation of spacers and a higher number of complications after implantation of the definitive prosthesis. Our study aimed to determine the reoperation rate of patients undergoing two-stage revision surgery according to the culture results of spacer sonication. METHODS A retrospective observational study was conducted in which hip or knee spacers implanted at our institution with a diagnosis of periprosthetic joint infection from 2010 to 2018 were analysed. Patients were grouped into three categories: A. Patients with positive spacer sonication fluid culture, with or without positive cultures of the rest of the samples. B. Patients with negative spacer sonication culture and negative cultures of the rest of intraoperative samples. C. Patients with negative spacer sonication culture but positive cultures of the rest of intraoperative samples. RESULTS A total of 45 spacers were analysed: 10 were included in group A, 24 in group B and 11 in group C. The reoperation rate during the first year after the 2-stage revision surgery was 20%, 29.2% and 54.5% for each group, respectively, due to an infection in 10%, 20.8% and 45.5%. Spacers were colonised in all cases by low virulent micro-organisms. CONCLUSION In our study, bacterial colonisation of the spacer is not associated with a higher rate of reoperation. The group of patients with positive intraoperative cultures during the second-stage had the highest reoperation rate.
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Affiliation(s)
- Sandra Huguet
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain.
- Department of Traumatology and Orthopaedics, Consorci Sanitari de l'Alt Penedès - Garraf, Barcelona, Spain.
| | - Martí Bernaus
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Lucía Gómez
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Infectious Diseases Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Eva Cuchí
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Department of Microbiology, CATLAB, Viladecavalls, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases - Osteoarticular Infections Unit, Hospital Clínic, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Department of Traumatology and Orthopaedics, Hospital Universitari Mútua Terrassa, Barcelona, Spain
- Osteoarticular Infections Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
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Cephalomedullary Nail as a Definitive Antibiotic Spacer for Multidrug Resistant Periprosthetic Infection of a Proximal Femoral Endoprosthesis. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Khanna A, Carter B, Gill I. Two-Stage Revision Hip Arthroplasty with or without the Use of an Interim Spacer for Managing Late Prosthetic Infection: A Systematic Review of the Literature. Orthop Surg 2021; 13:384-394. [PMID: 33554443 PMCID: PMC7957390 DOI: 10.1111/os.12875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/19/2020] [Accepted: 10/25/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of the present paper was to identify, appraise, and synthesize the available evidence on two-stage revision hip arthroplasty with or without the use of an interim spacer for managing late prosthetic infection. The review methodology was designed by referencing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and flow diagram, and a Population, Intervention, Comparator, Outcomes and Study (PICOS) design framework was used to search for studies to incorporate within the review. Two independent investigators were involved in searching for relevant articles that fulfilled the inclusion criteria for the study. Critical appraisal of the selected articles was carried out using the relevant Critical Appraisal Skills Programme checklists. From an initial pool of 125 articles, four studies satisfied the inclusion criteria and quality assessment and were included for final review. Two patient groups were identified from within the selected studies: spacer and non-spacer. Both groups were assessed in terms of functional outcome, infection cure rates, and technical difficulties encountered during treatment. Better functional outcome was reported in the spacer group, both in the interim period between the two stages and after completion of treatment. The use of spacers reduced operative difficulty during the second stage and accelerated patient discharge. Reinfection and infection persistence rates were higher in the non-spacer group. Within the spacer group, articulated spacers performed better in all parameters. The results of this review reinforce the available evidence supporting the use of interim hip spacers in revision hip arthroplasty for managing prosthetic infection and also indicate that articulated hip spacers could be an attractive option going forward.
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Affiliation(s)
- Angshuman Khanna
- Department of Trauma and OrthopaedicsSalford Royal NHS Foundation TrustSalfordUK
| | - Bernie Carter
- Faculty of HealthSocial Care and Medicine, Edge Hill UniversityOrmskirkUK
| | - Inder Gill
- Department of Trauma and OrthopaedicsSalford Royal NHS Foundation TrustSalfordUK
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13
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Sanz-Ruiz P, Matas-Diez JA, Villanueva-Martinez M, Carbo-Laso E, Lopez-Torres II, Vaquero-Martín J. A new biarticular cement spacer technique for infected total hip and knee arthroplasty with massive bone loss. Hip Int 2021; 31:242-249. [PMID: 31746228 DOI: 10.1177/1120700019884557] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The management of massive femoral bone defects following prosthetic infection remains a surgical challenge, particularly when the entire femur is affected. METHODS We present the first results of a new biarticular cement spacer with antibiotic technique using a cephalomedullary nail for the treatment of infected hip arthroplasty involving complete femoral bone loss. RESULTS 5 patients with a minimum follow-up of 1 year were included. In all cases 2-stage replacement due to hip periprosthetic infection was carried out, with the need for a biarticular complete femoral spacer in view of the magnitude of the bone defect. The infection was resolved in all patients, with no complications (spacer fracture or dislocation) associated to spacer use, and the patients were all able to maintain the sitting position with active knee movements between the 2 surgical stages. Improvement with respect to preoperative functional status was observed in all cases, as evidenced by the Harris Hip Score (HHS) (from 24.2 to 73; p < 0.001) and 12-Item Short-Form Health Survey (SF-12) (from 16.8 to 33.2; p = 0.001), with a lessened need for walking aids. DISCUSSION The described technique offers a possible solution to a number of complications observed with the use of spacers in massive defects, affording greater patient comfort and autonomy while waiting to receive total femoral replacement.
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Affiliation(s)
- Pablo Sanz-Ruiz
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Institute Avanfi, Madrid, Spain
| | - Jose Antonio Matas-Diez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Esther Carbo-Laso
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Irene Isabel Lopez-Torres
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Vaquero-Martín
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.,Faculty of Medicine, Complutense University of Madrid, Madrid, Spain
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14
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Pizzo RA, Patel JN, Viola A, Keller DM, Yoon RS, Liporace FA. Reducing Dislocations of Antibiotic Hip Spacers via Hybrid Cement-screw Constrained Liner Fixation: A Case Series. Hip Pelvis 2020; 32:207-213. [PMID: 33335869 PMCID: PMC7724021 DOI: 10.5371/hp.2020.32.4.207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Infection following total hip arthroplasty is a challenging and devastating complication. In two-stage revision arthroplasty, antibiotic spacers, although efficacious, can be associated with an unacceptable rate of mechanical complications (e.g., fracture, dislocation). This series describes 15 patients with infected total hip prostheses treated with hybrid cement-screw fixation constrained liner antibiotic spacers to enhance stability and minimize mechanical complications. Materials and Methods All patients with an infected hip prosthesis undergoing two-stage revision arthroplasty at a single academic medical center were identified and screened for inclusion. Clinical and radiographic data including patient demographics and outcome measures were collected and retrospectively analyzed. Results Two patients died of unrelated causes at an average of 6-week postoperatively. Infections in the remaining thirteen patients (100%) were successfully eradicated; all underwent uncomplicated revision arthroplasty at a mean duration of 99.5 days after the placement of the antibiotic spacer. No dislocations, fractures, or other mechanical failures of any spacer were observed in this series. Conclusion The hybrid cement-screw fixation technique for constrained liner antibiotic spacers is a reliable and effective treatment method for eradicating prosthetic joint infections without mechanical complications.
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Affiliation(s)
- Richard A Pizzo
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
| | - Jay N Patel
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
| | - Anthony Viola
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
| | - David M Keller
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
| | - Richard S Yoon
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
| | - Frank A Liporace
- Department of Orthopaedic Surgery, Jersey City Medical Center, Jersey City, NJ, USA
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15
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Wu XX, Zhang Y, Hu T, Li WX, Li ZL, Hu HJ, Zhu SR, Chen WZ, Zhou CS, Jiang GB. Long-term antibacterial composite via alginate aerogel sustained release of antibiotics and Cu used for bone tissue bacteria infection. Int J Biol Macromol 2020; 167:1211-1220. [PMID: 33189756 DOI: 10.1016/j.ijbiomac.2020.11.075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 02/08/2023]
Abstract
Bone related-bacterial diseases including wound infections and osteomyelitis (OM) remain a serious problem accompanied with amputation in most severe cases. In this work, we report an exceptional effective antibacterial alginate aerogel, which consists of tigecycline (TGC) and octahedral Cu crystal as an organo-inorganic synergy platform for antibacterial and local infection therapy applications. The alginate aerogel could greatly prolong the release of copper ions and maintain effective antibacterial concentration over 18 days. The result of in-vitro experiments demonstrated that the alginate aerogel has an exceptional effective function on antibacterial activity. Cytotoxicity tests indicated that the alginate aerogel has low biological toxicity (average cell viability >75%). These remarkable results suggested that the alginate aerogel exhibits great potential for the treatment of OM, and has a prosperous future of application in bone tissue engineering.
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Affiliation(s)
- Xia-Xiao Wu
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Yu Zhang
- Department of Orthopaedics, General Hospital of Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Tian Hu
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Wei-Xiong Li
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Zeng-Lin Li
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Han-Jian Hu
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Shui-Rong Zhu
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Wen-Zhao Chen
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China
| | - Chu-Song Zhou
- Department of Orthopaedics, Zhu-Jiang Hospital of Southern Medical University (First Military Medical University), Guangzhou 510282, China.
| | - Gang-Biao Jiang
- Key Laboratory for Biobased Materials and Energy of Ministry of Education, College of Materials and Energy, South China Agricultural University, Guangzhou 510642, China.
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16
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Hasan R, Wohlers A, Shreffler J, Mulinti P, Ostlie H, Schaper C, Brooks B, Brooks A. An Antibiotic-Releasing Bone Void Filling (ABVF) Putty for the Treatment of Osteomyelitis. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5080. [PMID: 33187199 PMCID: PMC7698155 DOI: 10.3390/ma13225080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/18/2022]
Abstract
The number of total joint replacements (TJR) is on the rise with a corresponding increase in the number of infected TJR, which necessitates revision surgeries. Current treatments with either non-biodegradable, antibiotic-releasing polymethylmethacrylate (PMMA) based bone cement, or systemic antibiotic after surgical debridement do not provide effective treatment due to fluctuating antibiotic levels at the site of infection. Here, we report a biodegradable, easy-to-use "press-fitting" antibiotic-releasing bone void filling (ABVF) putty that not only provides efficient antibiotic release kinetics at the site of infection but also allows efficient osseointegration. The ABVF formulation was prepared using poly (D,L-lactide-co-glycolide) (PLGA), polyethylene glycol (PEG), and polycaprolactone (PCL) as the polymer matrix, antibiotic vancomycin, and osseointegrating synthetic bone PRO OSTEON for bone-growth support. ABVF was homogenous, had a porous structure, was moldable, and showed putty-like mechanical properties. The ABVF putty released vancomycin for 6 weeks at therapeutic level. Furthermore, the released vancomycin showed in vitro antibacterial activity against Staphylococcus aureus for 6 weeks. Vancomycin was not toxic to osteoblasts. Finally, ABVF was biodegradable in vivo and showed an effective infection control with the treatment group showing significantly higher bone growth (p < 0.001) compared to the control group. The potential of infection treatment and osseointegration makes the ABVF putty a promising treatment option for osteomyelitis after TJR.
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Affiliation(s)
- Raquib Hasan
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Abbey Wohlers
- Department of Pharmacy, North Dakota State University, Fargo, ND 58102, USA;
| | - Jacob Shreffler
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Pranothi Mulinti
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
| | - Hunter Ostlie
- School of Medicine, St. George’s University, University Centre Grenada, West Indies, Grenada;
| | - Codi Schaper
- College of Veterinary Medicine, Kansas State University, Manhattan, KS 66502, USA;
| | - Benjamin Brooks
- Department of Biomedical Sciences, Rocky Vista University, Ivins, UT 84734, USA;
| | - Amanda Brooks
- Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND 58102, USA; (R.H.); (J.S.); (P.M.)
- Department of Research and Scholarly Activity, Rocky Vista University, Ivins, UT 84734, USA
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17
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Research into biocompatibility and cytotoxicity of daptomycin, gentamicin, vancomycin and teicoplanin antibiotics at common doses added to bone cement. Jt Dis Relat Surg 2020; 31:328-334. [PMID: 32584733 PMCID: PMC7489165 DOI: 10.5606/ehc.2020.74943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/23/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aims to investigate the biocompatibility and cytotoxicity of daptomycin, gentamicin, vancomycin and teicoplanin at commonly-used dose intervals added to polymethylmethacrylate (PMMA) in vitro. MATERIALS AND METHODS This prospective study was conducted between February 2016 and June 2016. Antibiotics were added to PMMA at doses frequently used in clinical practice. The antibiotic doses added were teicoplanin (2 g, 3 g, 4 g), gentamicin (0.5 g, 0.75 g, 1 g), daptomycin (0.5 g.) and vancomycin (2 g, 3 g, 4 g). Standard cement balls (10 mm) were created. Activated L929 mouse fibroblast cell culture was used for incubation. Agar diffusion, Cell Proliferation Kit II (XTT) test and electron microscope investigations were performed to examine biocompatibility and cytotoxicity. RESULTS In the cytotoxicity test, teicoplanin at 4 g and daptomycin at 0.5 g doses were observed to cause reductions in viability percentages. The same doses caused 20% and 20-40% cell lysis indices during the agar diffusion test. On electron microscope images, cytotoxic effects in fibroblast cells and involvement with the surface of cement balls were observed. CONCLUSION Gentamicin, vancomycin and teicoplanin were observed to be non-toxic and biocompatible at commonly-used dose intervals. Teicoplanin at 4 g and daptomycin at 0.5 g doses were identified to be cytotoxic and not biocompatible. When selecting antibiotics to be added to bone cement, care should be taken that the antibiotic is non-toxic and biocompatible.
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18
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Ajit Singh V, Chun Haw B, Haseeb A, Shuan Ju Teh C. Hand-mixed vancomycin versus commercial tobramycin cement revisited: A study on mechanical and antibacterial properties. J Orthop Surg (Hong Kong) 2020; 27:2309499019839616. [PMID: 30943842 DOI: 10.1177/2309499019839616] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Arthroplasty-related infection has grown worldwide. Revision procedures for infection are associated with longer operating time, superior amounts of blood loss, and substantial economic encumbrance. To overcome cost, many surgeons opt for hand-mixed vancomycin into the bone cement. The objective of this research was to assess the biomechanical strength and antibacterial properties of hand-mixed vancomycin bone cement at different concentrations with commonly used industrial preblended antibiotic bone cement and plain cement. The target was to determine the ideal concentration of antibiotics that can be used in the preparation of hand-mixed vancomycin cement that delivers maximum antibiotics concentration without compromising its biomechanical properties. MATERIALS AND METHODS Vancomycin-impregnated polymethyl methacrylate (PMMA) specimen was hand prepared in varying concentrations (1-4 g). The authors tested three-point bending strength to determine 'maximum bending load' and stiffness and its antibacterial activity by looking into the zone of inhibition on methicillin-resistant Staphylococcus aureus-impregnated agar plate. These were compared with the industrial preblended Simplex™ P with 1 g tobramycin. RESULTS This study exhibited that vancomycin-PMMA disk that contained higher concentration of antibiotics had significantly higher antibacterial activity. The control group (plain cement) and industrial PMMA with preblended antibiotic (tobramycin) showed stable mechanical strength, while the hand-mixed antibiotic cement (HMAC) had variable mechanical strength varying on the concentration of antibiotics used. CONCLUSION It was effectively concluded that HMAC is advantageous as a cement spacer; however, it is not recommended for primary arthroplasty and second-stage revision arthroplasty. The recommended maximum concentration of vancomycin based on this study is 2 g/pack (40 g) of cement. Industrial preblended antibiotic cement is superior to hand-mixed cement.
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Affiliation(s)
- Vivek Ajit Singh
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bong Chun Haw
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Amber Haseeb
- 1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Cindy Shuan Ju Teh
- 2 Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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19
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Sporer SM. Spacer Design Options and Consideration for Periprosthetic Joint Infection. J Arthroplasty 2020; 35:S31-S34. [PMID: 32046828 DOI: 10.1016/j.arth.2019.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 02/01/2023] Open
Abstract
An articulating or nonarticulating antibiotic hip spacer can be placed following the first stage implant removal of a periprosthetic hip joint infection. Antibiotic spacers help fill in the dead space created at the time of resection and provide a high local concentration of antibiotics. Theoretical advantages of a static spacer include a higher elution of antibiotics because of the increased surface area, the ability to protect deficient bone in the proximal femur/acetabulum, and the ability to immobilize the periarticular soft tissues. Advantages of an articulating spacer include improved ambulation and easier motion for the patient, maintenance of soft tissue tension, and an easier surgical reconstruction at the time of the second stage. Additionally, an articulating antibiotic spacer may minimize the risk of dislocation following the second stage reconstruction. The choice of articulating or nonarticulating is currently one of surgeon preference yet it is advised that surgeons consider an articulating spacer for all patients except those with severe femoral/acetabular bone loss or deficient abductors.
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20
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Addressing Antibiotic Hip Spacer Instability via Hybrid Screw-cement Fixation of a Constrained Liner and Cement-rebar Interface Techniques: A Technical Narrative. J Am Acad Orthop Surg 2020; 28:166-170. [PMID: 31567542 DOI: 10.5435/jaaos-d-19-00116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Prosthetic joint infection is a challenging and devastating complication after total hip arthroplasty. The benchmark for treatment remains two-stage revision arthroplasty, in which an antibiotic-impregnated spacer is used to eradicate the infection. Although several types of spacer constructs have been described, they have historically been associated with high rates of mechanical complications, namely, dislocation, spacer fracture, and periprosthetic femur fracture. Spacer dislocation is the most common, with reported rates as high as 41%. Here, the authors present a surgical technique to improve the mechanical stability of an articulating hip spacer via a hybrid screw-cement fixation technique that allows for joint motion and weight bearing during the treatment period while minimizing the risk of mechanical failure. An additional technique is described to address acetabular bone loss, which has been associated with a higher spacer dislocation rate, through a cement-rebar interface construct.
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21
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Mittal S, Agrawal A, Sakale H, Yadav S. Complications following fracture neck of femur treated with austin moore hemiarthroplasty: A rare case report. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2020. [DOI: 10.4103/jotr.jotr_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Dall GF, Tsang STJ, Gwynne PJ, MacKenzie SP, Simpson AHRW, Breusch SJ, Gallagher MP. Unexpected synergistic and antagonistic antibiotic activity against Staphylococcus biofilms. J Antimicrob Chemother 2019; 73:1830-1840. [PMID: 29554250 DOI: 10.1093/jac/dky087] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/15/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate putative anti-staphylococcal biofilm antibiotic combinations used in the management of periprosthetic joint infections (PJIs). Methods Using the dissolvable bead biofilm assay, the minimum biofilm eradication concentration (MBEC) was determined for the most commonly used antimicrobial agents and combination regimens against staphylococcal PJIs. The established fractional inhibitory concentration (FIC) index was modified to create the fractional biofilm eradication concentration (FBEC) index to evaluate synergism or antagonism between antibiotics. Results Only gentamicin (MBEC 64 mg/L) and daptomycin (MBEC 64 mg/L) were observed to be effective antistaphylococcal agents at clinically achievable concentrations. Supplementation of gentamicin with daptomycin, vancomycin or ciprofloxacin resulted in a similar or lower MBEC than gentamicin alone (FBEC index 0.25-2). Conversely, when rifampicin, clindamycin or linezolid was added to gentamicin, there was an increase in the MBEC of gentamicin relative to its use as a monotherapy (FBEC index 8-32). Conclusions This study found that gentamicin and daptomycin were the only effective single-agent antibiotics against established Staphylococcus biofilms. Interestingly the addition of a bacteriostatic antibiotic was found to antagonize the ability of gentamicin to eradicate Staphylococcus biofilms.
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Affiliation(s)
- G F Dall
- Department of Orthopaedic Surgery, Borders General Hospital, Huntlyburn, Melrose TD6 9BS, UK.,School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - S-T J Tsang
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK.,Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK.,Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - P J Gwynne
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
| | - S P MacKenzie
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - A H R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - S J Breusch
- Department of Orthopaedic Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - M P Gallagher
- School of Biological Sciences, University of Edinburgh, Darwin Building, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
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23
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Chen L, Al-Shawk A, Rea C, Mazeh H, Wu X, Chen W, Li Y, Song W, Markel DC, Ren W. Preparation of electrospun nanofibers with desired microstructures using a programmed three-dimensional (3D) nanofiber collector. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 106:110188. [PMID: 31753331 DOI: 10.1016/j.msec.2019.110188] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023]
Abstract
The traditional electrospinning process produces dense two-dimensional (2D) nanofiber (NF) sheets that limit cell infiltration and proliferation. Our previous study demonstrated that 3D NF sheets could be formed on an NF collector surface mounted with multiple movable needles through the corona discharge. In this study, we developed a programmed electrospun 3D NF collector. It can precisely control the moving speed of NF collector during electrospinning; thereby fabricating 3D NFs with desired microstructures (pore size, pore volume, and interconnectivity). Four types of polycaprolactone (PCL) 3D NF matrices with different microstructures can be obtained concurrently on the NF collector surface, which are set by different forward moving speed of the NF collector device: NF-zero (no move, as control), NF-low (0.085 mm/min), NF-mid (0.158 mm/min) and NF-high (0.232 mm/min). A linear increase of the NF sheet thickness (from 0.21 mm to 0.91 mm) was recorded with accelerating collector movement. Quantitative analysis using scanning electron microscopy (SEM), micro-computed tomography (μ-CT), and confocal laser scanning microscopy (CLSM) showed a monotonic increase of pore size and porosity with the increase of collector moving speeds. The collector movement also impacted the crystallinity and mechanical properties of the NFs. When prepared at high collector speed, the NFs showed improved proliferation and differentiation (p < .05) of pre-osteoblastic MC3T3 cells compared to the NFs from the static collector. A programmed NF collector device allows for the reproducible, precise and continuous fabrication of 3D NFs with tailorable geometry and microstructures. This simple, controllable, one-step process could promote the clinical translation of electrospun NFs in tissue engineering and regenerative medicine.
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Affiliation(s)
- Liang Chen
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Ameer Al-Shawk
- Department of Mechanic Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Christopher Rea
- Department of Engineering Technology, Wayne State University, Detroit, MI 48201, USA
| | - Hanan Mazeh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Xin Wu
- Department of Mechanic Engineering, Wayne State University, Detroit, MI 48201, USA
| | - Wen Chen
- Department of Engineering Technology, Wayne State University, Detroit, MI 48201, USA
| | - Yawen Li
- Department of Biomedical Engineering, Lawrence Technological University, Southfield, MI 48075, USA
| | - Wei Song
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA
| | - David C Markel
- Department of Orthopedics, Providence Hospital and Medical Center, Southfield, MI 48075, USA
| | - Weiping Ren
- Department of Biomedical Engineering, Wayne State University, Detroit, MI 48201, USA; Department of Orthopedics, Providence Hospital and Medical Center, Southfield, MI 48075, USA; John D. Dingle VA Medical Center, Detroit, MI 48202, USA.
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24
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Yang FS, Lu YD, Wu CT, Blevins K, Lee MS, Kuo FC. Mechanical failure of articulating polymethylmethacrylate (PMMA) spacers in two-stage revision hip arthroplasty: the risk factors and the impact on interim function. BMC Musculoskelet Disord 2019; 20:372. [PMID: 31412841 PMCID: PMC6694660 DOI: 10.1186/s12891-019-2759-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 08/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This study aimed to investigate the risk factors for mechanical failure of cement spacers and the impact on hip function after two-stage exchange arthroplasty for periprosthetic joint infection (PJI). METHODS Thirty-one patients (19 males and 12 females) with hip PJIs underwent resection arthroplasty and implantation of cement spacers from January 2014 to December 2015. Patients who encountered spacer-associated mechanical complications in the interim period (14 of 31) were compared with those without complications (17 of 31). Complications were defined as spacer dislocation, spacer fracture, spacer fracture with dislocation, and femoral fracture during or following spacer implantation. Hip functional outcome was assessed using the Harris hip score (HHS). Treatment success was defined according to the following criteria: (1) no symptoms or signs indicative of infection; (2) no PJI-related mortality; and (3) no subsequent surgical intervention for infection after reimplantation surgery. Multivariate logistic regression and Kaplan-Meier survival curves were used for analysis. RESULTS Fourteen patients (14/31 = 45%) suffered at least one spacer-related complication within the interim period. The development of spacer complications was associated with a younger age (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.83-1.00, p = 0.045) and chronic PJI (OR 14.7, 95% CI 1.19-182, p = 0.036). Patients with spacer complications also had a lower median HHS (37 vs. 60, p < 0.001) before reimplantation in comparison to those without spacer complications. After reimplantation, the two groups had a similar median HHS (90 vs. 89, p = 0.945). Two patients did not undergo reimplantation due to extensive comorbidities, and subsequently retained the antibiotic spacer for definitive treatment. The 2-year treatment success rate was 84.6% in the spacer-complication group and 87.5% in the non-spacer-complication group (p = 0.81). CONCLUSION There was a high complication rate for articulating PMMA spacers during the interim period of two-stage revision total hip arthroplasty. A young age and chronic infection were the primary risk factors associated with mechanical complications. Patients at high risk of spacer-related mechanical complications should be advised accordingly by surgeons. Knowing the possible risk factors, surgeons should educate patients thoroughly to avoid spacer complications, thereby increasing patient satisfaction in the interim stage. LEVEL OF EVIDENCE Prognostic Level III.
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Affiliation(s)
- Fu-Shine Yang
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Yu-Der Lu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Cheng-Ta Wu
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Kier Blevins
- Department of Orthopaedic Surgery, Duke University Medical Center, Box 3000, Durham, NC 27710 USA
| | - Mel S. Lee
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
| | - Feng-Chih Kuo
- Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, No 123, Ta Pei Road, Niao Sung Dist, Kaohsiung, 833 Taiwan
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Luk MH, Ng FY, Fu H, Chan PK, Yan CH, Chiu KY. Retention of prosthetic articulating spacer after infected hip arthroplasty as a semipermanent implant: A case report. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2019. [DOI: 10.1177/2210491719864115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Prosthesis with antibiotic-loaded acrylic cement was designed as a temporary articulating cement spacer in a two-stage procedure before definitive reimplantation for the treatment of periprosthetic joint infections. It is designed to remain in situ for about 6–12 weeks, until evidence of infection is controlled before reimplantation of a definitive total hip replacement. This study presents a case of a patient with prosthetic articulating spacer retention for 6 years, previously performed for an infected unipolar hemiarthroplasty for which he refused second-stage reimplantation. He remains relatively asymptomatic with no evidence of infection, implant loosening, or fracture. The patient is able to walk with a frame with minimal hip pain.
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Affiliation(s)
- Michelle Hilda Luk
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Henry Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ping Keung Chan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Chun Hoi Yan
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Sancineto CF, Pereira Duarte M, Garcia Mansilla I, Taype Zamboni DRE, Carabelli GS, Barla JD. Preliminary outcomes of proximal femur megaspacers. Arthroplast Today 2019; 5:164-171. [PMID: 31286038 PMCID: PMC6588803 DOI: 10.1016/j.artd.2018.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/16/2018] [Accepted: 09/21/2018] [Indexed: 12/12/2022] Open
Abstract
There are very few therapeutic alternatives for patients with proximal femoral epiphyseal bone deficit combined with a fracture at another level and signs of infection. This combination can be successfully managed with a proximal femur megaspacer. This article is intended to review our variation of this technique and to show the initial results obtained from 11 cases. Of these 11 cases, there were 6 women and 5 men. The mean age was 66 years. The average number of previous surgeries was 3. Definitive prosthetic reconstructive treatment was achieved in 7 of these 11 subjects. The average time to reimplantation was 11.7 months. Fractures or nonunion healed uneventfully. Bone union and infection control were achieved in 10 of the 11 patients.
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Affiliation(s)
- Carlos Federico Sancineto
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Matias Pereira Duarte
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Ignacio Garcia Mansilla
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina
| | | | - Guido Sebastian Carabelli
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina
| | - Jorge Daniel Barla
- Department of Orthopedic Surgery "Prof. Dr. Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, CABA, Argentina
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Jones CW, Selemon N, Nocon A, Bostrom M, Westrich G, Sculco PK. The Influence of Spacer Design on the Rate of Complications in Two-Stage Revision Hip Arthroplasty. J Arthroplasty 2019; 34:1201-1206. [PMID: 30879874 DOI: 10.1016/j.arth.2019.02.012] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 01/27/2019] [Accepted: 02/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antibiotic cement spacers are used during 2-stage revision total hip arthroplasty for prosthetic joint infection. Complications including dislocation and periprosthetic fracture have been reported but a large cohort comparing spacer design features is lacking. We aimed to determine if spacer design is associated with perioperative complications. METHODS We performed a retrospective review of antibiotic cement spacers implanted between 2004 and 2014. Radiographic assessment included leg length, offset, and bone loss (Paprosky classification). Clinical outcomes included dislocation, periprosthetic fracture, spacer fracture, infection cure, and overall reoperation rate. Univariate analysis, Student's t-test, chi-squared test, or Kruskal-Wallis test was employed (P < .05). RESULTS One hundred eighty-five patients were treated: 42% were female and mean age was 64 years (range 24-93, standard deviation 13.6). Spacer types were (1) molded (53%), (2) antibiotic-coated prosthesis (30%), (3) handmade (12%); and (4) prefabricated (4%). Cemented acetabular liners were used in 3% (6/185). There was no loss to follow-up during the interstage period. Spacer complications occurred in 26% (48/185). Dislocation occurred in 9% (17/185) and was associated with reduced femoral offset of >5 mm (P = .033) and increased bone loss (P = .01). Spacer fracture occurred in 8% (14/185); 12% (12/97) molded versus 8% (2/23) handmade (P = .02). Periprosthetic femur fracture was associated with increased offset >5 mm (P = .01) and extended trochanteric osteotomy (P = .001). CONCLUSION During 2-stage total hip arthroplasty, antibiotic-loaded cement spacers had an overall complication rate of 26%. Spacer design, acetabular and femoral bone loss, and offset restoration were significantly associated with perioperative complications. We recommend the optimization of antibiotic-loaded cement spacer placement to minimize potential complications by focusing on restoration of leg-length and offset, ensuring adequate femoral fixation and paying attention to selection of an appropriate head/neck ratio.
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Affiliation(s)
- Christopher W Jones
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
| | - Nicolas Selemon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
| | - Allina Nocon
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
| | - Mathias Bostrom
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
| | - Geoffrey Westrich
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
| | - Peter K Sculco
- Complex Joint Reconstruction Center, Hospital for Special Surgery, New York City, NY
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28
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Volejníková A, Melicherčík P, Nešuta O, Vaňková E, Bednárová L, Rybáček J, Čeřovský V. Antimicrobial peptides prevent bacterial biofilm formation on the surface of polymethylmethacrylate bone cement. J Med Microbiol 2019; 68:961-972. [PMID: 31107198 DOI: 10.1099/jmm.0.001000] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Antibiotic-loaded polymethylmethacrylate-based bone cement has been implemented in orthopaedics to cope with implant-related infections associated with the formation of bacterial biofilms. In the context of emerging bacterial resistance to current antibiotics, we examined the efficacy of short antimicrobial peptide-loaded bone cement in inhibiting bacterial adhesion and consequent biofilm formation on its surface. METHODOLOGY The ability of α-helical antimicrobial peptides composed of 12 amino acid residues to prevent bacterial biofilm [methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Pseudomonas aeruginosa and Escherichia coli] formation on the surface of model implants made from polymethylmethacrylate-based bone cement was evaluated by colony-forming unit (c.f.u.) counting of bacteria released by sonication from the biofilms formed on their surfaces. The biofilms on model implant surfaces were also visualized by light microscopy after staining with tetrazolium dye (MTT) and by scanning electron microscopy. RESULTS When incorporated in the implants, these peptides caused a mean reduction in the number of bacterial cells attached to implants' surfaces (by five orders of magnitude), and 88 % of these implants showed no bacterial adhesion after being exposed to growth media containing various bacteria. CONCLUSION The results showed that the antibiofilm activity of these peptides was comparable to that of the antibiotics, but the peptides exhibited broader specificity than the antibiotics. Given the rapid development of antibiotic resistance, antimicrobial peptides show promise as a substitute for antibiotics for loading into bone cements.
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Affiliation(s)
- Andrea Volejníková
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
| | - Pavel Melicherčík
- 2 Department of Orthopaedics, First Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Czech Republic
| | - Ondřej Nešuta
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
| | - Eva Vaňková
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
| | - Lucie Bednárová
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
| | - Jiří Rybáček
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
| | - Václav Čeřovský
- 1 Institute of Organic Chemistry and Biochemistry of the Czech Academy of Sciences, Flemingovo nám. 2, 166 10 Prague 6, Czech Republic
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29
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Sanz-Ruiz P, Matas-Diez J, Calvo-Haro J, Solans M, Vaquero-Martín J. Biarticular total femoral spacer for complete bone loss in periprosthetic joint infection. A technical modification. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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30
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Perni S, Caserta S, Pasquino R, Jones SA, Prokopovich P. Prolonged Antimicrobial Activity of PMMA Bone Cement with Embedded Gentamicin-Releasing Silica Nanocarriers. ACS APPLIED BIO MATERIALS 2019; 2:1850-1861. [DOI: 10.1021/acsabm.8b00752] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Stefano Perni
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
| | - Sergio Caserta
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Rossana Pasquino
- Department of Chemical, Materials and Industrial Production Engineering, University of Naples Federico II, Napoli 80125, Italy
| | - Steve A. Jones
- University Hospital Llandough, Cardiff & Vale University Health Board, Penlan Road, Penarth, Vale of Glamorgan, Wales CF64 2XX, United Kingdom
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff CF10 3NB, United Kingdom
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31
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Principles and current concepts in the surgical treatment of fragility fractures in the elderly. Best Pract Res Clin Rheumatol 2019; 33:264-277. [DOI: 10.1016/j.berh.2019.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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32
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Azuara G, García-García J, Ibarra B, Parra-Ruiz F, Asúnsolo A, Ortega M, Vázquez-Lasa B, Buján J, San Román J, de la Torre B. Experimental study of the application of a new bone cement loaded with broad spectrum antibiotics for the treatment of bone infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019. [DOI: 10.1016/j.recote.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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33
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Sukeik M, Haddad FS. Periprosthetic joint infections after total hip replacement: an algorithmic approach. SICOT J 2019; 5:5. [PMID: 30816089 PMCID: PMC6394232 DOI: 10.1051/sicotj/2019004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/28/2019] [Indexed: 12/25/2022] Open
Abstract
An algorithm for managing periprosthetic joint infections (PJIs) after total hip replacement (THR) surgery using a multidisciplinary approach and a clearly defined protocol may improve infection eradication rates. In this article, we present an algorithm for the management of different types of PJIs including the acutely infected cemented and cementless THRs where the components are well-fixed postoperatively and when the infection is secondary to haematogenous spread in previously well-functioning and well-fixed implants. For chronic PJIs where the components are often loose, the standard treatment includes a two-stage revision procedure. However, in a highly selected subset of patients, a single-stage approach has been utilised with high rates of eradicating infections.
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Affiliation(s)
- Mohamed Sukeik
- Foothills Medical Centre, 1403 29 St NW Calgary, AB T2N 2T9, Canada
| | - Fares Sami Haddad
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK
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34
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Ibarra B, García-García J, Azuara G, Vázquez-Lasa B, Ortega MA, Asúnsolo Á, San Román J, Buján J, García-Honduvilla N, De la Torre B. Polylactic-co-glycolic acid microspheres added to fixative cements and its role on bone infected architecture. J Biomed Mater Res B Appl Biomater 2019; 107:2517-2526. [PMID: 30784189 PMCID: PMC6790951 DOI: 10.1002/jbm.b.34342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 09/24/2018] [Accepted: 01/26/2019] [Indexed: 12/19/2022]
Abstract
Joint prostheses are an essential element to improve quality of life. However, prostheses may fail due to several factors, including the most frequent cause, Staphylococcus aureus infection. The identification of new fixing bone cements with less reactivity on bone tissue and an adequate response to infection remains a primary challenge. The aim of this study is to evaluate the response of bone tissue in rabbits after introduction of a hydroxyapatite‐coated titanium rod with a commercial fixative cement (Palacos®) compared to a modified experimental cement (EC) containing polylactic‐co‐glycolic acid (PLGA) microspheres in the presence or absence of contaminating germs. This study used 20 New Zealand rabbits which were divided into four groups (n = 5) depending on the presence or absence of S. aureus and the use of commercial (Palacos®) or EC. A histological method, based on bone architecture damage, was proposed to evaluate from 1 to 9 the histological results and the response of the infected tissue. The macrophage response was also evaluated using monoclonal antibody RAM‐11. The study showed better bone conservation with the use of EC with PLGA microspheres against the Palacos® commercial cement, including the noncontaminated and contaminated groups. © 2019 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B:2517–2526, 2019.
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Affiliation(s)
- Blanca Ibarra
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain
| | - Joaquin García-García
- Service of Orthopedic Surgery of University Hospital Principe de Asturias, Madrid, Spain
| | - Galo Azuara
- Service of Traumatology of University Hospital of Guadalajara, Madrid, Spain
| | - Blanca Vázquez-Lasa
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain
| | - Miguel A Ortega
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain
| | - Ángel Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Julio San Román
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain
| | - Julia Buján
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Natalio García-Honduvilla
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Institute of Polymer Science and Technology (ICTP-CSIC), Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
| | - Basilio De la Torre
- Service of Traumatology of University Hospital Ramón y Cajal, Madrid, Spain.,Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, Spain
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35
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Azuara G, García-García J, Ibarra B, Parra-Ruiz FJ, Asúnsolo A, Ortega MA, Vázquez-Lasa B, Buján J, San Román J, de la Torre B. Experimental study of the application of a new bone cement loaded with broad spectrum antibiotics for the treatment of bone infection. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:95-103. [PMID: 30611707 DOI: 10.1016/j.recot.2018.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 07/16/2018] [Accepted: 10/01/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the in vivo behaviour of a new bone cement loaded with antibiotics, in a rabbit bone infection model. MATERIAL AND METHODS Sixteen New Zealand rabbits divided into 4 groups were used, depending on the cement (commercial or experimental) and the antibiotic (vancomycin or linezolid) used to control a bone infection caused by Staphylococcus aureus. The commercial cement is Palacos® R and the experimental cement has been achieved by adding PLGA to the solid phase of Palacos® R cement. A novel histological staging method based on bone histoarchitecture has been used. This staging allows us a global vision of bone repair capacity, in the presence of modified cement, and also allows us to correlate the damage generated with the functionality of the tissue. RESULTS The degree of bone destructuration found depended on the type of cement and antibiotic, and was higher in the groups with commercial cement than in the experimental group (P<.01) and in the groups with linezolid with respect to vancomycin (P=.04) The percentage of macrophages varied exclusively depending on the antibiotic used, and was higher in the vancomycin groups (P=.04). DISCUSSION The development of new formulations of bone cement that release more, and more prolonged, new generation antibiotics such as linezolid, present an in vivo behaviour superior to commercial cement, respecting the bone structure. This behaviour would have a clinical implication in fighting infections by increasingly resistant germs in the treatment of prosthetic infection.
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Affiliation(s)
- G Azuara
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Service of Traumatology and Orthopedic Surgery, University Hospital of Guadalajara, Guadalajara, España
| | - J García-García
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Service of Traumatology and Orthopedic Surgery, University Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, España
| | - B Ibarra
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España
| | - F J Parra-Ruiz
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España
| | - A Asúnsolo
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, España
| | - M A Ortega
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España; Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, España
| | - B Vázquez-Lasa
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España
| | - J Buján
- Departments of Medicine and Medical Specialities, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, España; Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España; Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, España
| | - J San Román
- Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, España
| | - B de la Torre
- Ramón y Cajal Institute of Sanitary Research (IRYCIS), Madrid, España; Service of Traumatology and Orthopedic Surgery, University Hospital Ramón y Cajal, Madrid, España.
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36
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Sanz-Ruiz P, Matas-Diez JA, Calvo-Haro JA, Solans MC, Vaquero-Martín J. Biarticular total femoral spacer for complete bone loss in periprosthetic joint infection. A technical modification. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 63:192-201. [PMID: 30594575 DOI: 10.1016/j.recot.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/03/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The management of complete bone defects in hip and knee periprosthetic infection is still a real surgical challenge. MATERIAL AND METHODS We present a technical modification for performing a biarticular total femoral spacer with a femoral nail without the need to approach the proximal tibia. RESULTS Three patients were operated with this technique. There was no intraoperative complication. The infection was resolved in all patients operated at final follow-up. All patients improved their previous functional situation and could walk with different aids. CONCLUSIONS This technical modification is an alternative for cases where it is necessary to resect the complete femur, but it is not necessary to approach the tibia.
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Affiliation(s)
- P Sanz-Ruiz
- Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - J A Matas-Diez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J A Calvo-Haro
- Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - M C Solans
- Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Vaquero-Martín
- Departamento de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Taha M, Abdelbary H, Ross FP, Carli AV. New Innovations in the Treatment of PJI and Biofilms-Clinical and Preclinical Topics. Curr Rev Musculoskelet Med 2018; 11:380-388. [PMID: 29926287 PMCID: PMC6105481 DOI: 10.1007/s12178-018-9500-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement. A main source for antibiotic tolerance and treatment failure is bacterial production of biofilm-a resilient barrier against antibiotics, immune system, and mechanical debridement. The purpose of this review is to explore some novel approaches to treat PJI and biofilm-related infections. RECENT FINDINGS Innovative treatment strategies of bacterial and biofilm infections revolve around (a) augmenting current therapies, such as improving the delivery and efficiency of conventional antibiotics and enhancing the efficacy of antiseptics and (b) administrating completely new therapeutic modalities, such as using immunotherapy, nanoparticles, lytic bacteriophages, photodynamic therapy, novel antibiotics, and antimicrobial peptides. Several promising treatment strategies for PJI are available to be tested further. The next requirement for most of the novel treatments is reproducing their effects in clinically representative animal models of PJI against clinical isolates of relevant bacteria.
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Affiliation(s)
- Mariam Taha
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - Hesham Abdelbary
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada
| | - F Patrick Ross
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA
| | - Alberto V Carli
- Division of Orthopedic Surgery Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
- Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA.
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Tatara AM, Rozich AJ, Kontoyiannis PD, Watson E, Albert ND, Bennett GN, Mikos AG. Econazole-releasing porous space maintainers for fungal periprosthetic joint infection. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:70. [PMID: 29752591 PMCID: PMC6009980 DOI: 10.1007/s10856-018-6073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/21/2018] [Indexed: 06/08/2023]
Abstract
While antibiotic-eluting polymethylmethacrylate space maintainers have shown efficacy in the treatment of bacterial periprosthetic joint infection and osteomyelitis, antifungal-eluting space maintainers are associated with greater limitations for treatment of fungal musculoskeletal infections including limited elution concentration and duration. In this study, we have designed a porous econazole-eluting space maintainer capable of greater inhibition of fungal growth than traditional solid space maintainers. The eluted econazole demonstrated bioactivity in a concentration-dependent manner against the most common species responsible for fungal periprosthetic joint infection as well as staphylococci. Lastly, these porous space maintainers retain compressive mechanical properties appropriate to maintain space before definitive repair of the joint or bony defect.
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Affiliation(s)
- Alexander M Tatara
- Department of Bioengineering, Rice University, Houston, TX, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Emma Watson
- Department of Bioengineering, Rice University, Houston, TX, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, USA
| | - Nathaniel D Albert
- Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Antonios G Mikos
- Department of Bioengineering, Rice University, Houston, TX, USA.
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Mariaux S, Furustrand Tafin U, Borens O. Diagnosis of Persistent Infection in Prosthetic Two-Stage Exchange: Evaluation of the Effect of Sonication on Antibiotic Release from Bone Cement Spacers. J Bone Jt Infect 2018; 3:37-42. [PMID: 29545994 PMCID: PMC5852846 DOI: 10.7150/jbji.23668] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/31/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction: When treating periprosthetic joint infection with a two-stage procedure, antibiotic-impregnated spacers can be used in the interval between prosthetic removal and reimplantation. In our experience, cultures of sonicated spacers are most often negative. The objective of the study was to assess whether that sonication causes an elution of antibiotics, leading to elevated antibiotic concentrations in the sonication fluid inhibiting bacterial growth and thus causing false-negative cultures. Methods: A prospective monocentric study was performed from September 2014 to March 2016. Inclusion criteria were a two-stage procedure for prosthetic infection and agreement of the patient to participate in the study. Spacers were made of gentamicin-containing cement to which tobramycin and vancomycin were added. Antibiotic concentrations in the sonication fluid were determined by mass-spectometry (LC-MS). Results: 30 patients were identified (15 hip and 14 knee and 1 ankle arthroplasties). No cases of culture positive sonicated spacer fluid were observed in our serie. In the sonication fluid median concentrations of 13.2µg/ml, 392 µg/ml and 16.6 µg/ml were detected for vancomycin, tobramycin and gentamicin, respectively. According to the European Committee on antimicrobial susceptibility testing (EUCAST), these concentrations released from cement spacer during sonication are higher than the minimal inhibitory concentrations (MICs) for most bacteria relevant in prosthetic joint infections. Conclusion:Spacer sonication cultures remained sterile in all of our cases. Elevated concentrations of antibiotics released during sonication could explain partly negative-cultured sonicated spacers. Indeed, the absence of antibiotic free interval during the two-stages can also contribute to false-negative spacers sonicated cultures.
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Affiliation(s)
- Sandrine Mariaux
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Ulrika Furustrand Tafin
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
| | - Olivier Borens
- Service of Orthopaedics and Traumatology, Lausanne University Hospital, Avenue Pierre-Decker 4, 1011 Lausanne Switzerland
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Application of Calcium Sulfate for Dead Space Management in Soft Tissue: Characterisation of a Novel In Vivo Response. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8065141. [PMID: 29693016 PMCID: PMC5859833 DOI: 10.1155/2018/8065141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/16/2018] [Indexed: 12/03/2022]
Abstract
Management of dead space (DS) is a fundamental aspect of surgery. Residual DS following surgery can fill with hematoma and provide an environment for bacterial growth, increasing the incidence of postoperative infection. Materials for managing DS include polymethyl-methacrylate (PMMA), which is nonresorbing and requires removal in a second surgical procedure. The use of calcium sulfate (CS) offers the advantage of being fully absorbed and does not require subsequent surgical removal. As CS has historically been used as a bone void filler, there are some concerns for the risk of heterotopic ossification (HO) when implanted adjacent to soft tissue. This study assessed the osteoinductive potential of CS and identified and characterised residual material present in muscle tissue using histology, energy-dispersive X-ray spectroscopy analysis, and scanning electron microscopy (SEM). CS beads with and without antibiotic were implanted in intramuscular sites in both athymic rats and New Zealand white rabbits. At 28 days after implantation in the rat model, no signs of osteoinduction were observed. In the rabbit model, at 21 days after implantation, almost complete bead absorption and presence of a “halo” of material in the surrounding muscle tissue were confirmed. Our results suggested that the halo of material was a calcium phosphate precipitate, not HO.
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Studies on the cytocompatibility, mechanical and antimicrobial properties of 3D printed poly(methyl methacrylate) beads. Bioact Mater 2018; 3:157-166. [PMID: 29744453 PMCID: PMC5935776 DOI: 10.1016/j.bioactmat.2018.01.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/26/2018] [Accepted: 01/27/2018] [Indexed: 01/09/2023] Open
Abstract
Osteomyelitis is typically a bacterial infection (usually from Staphylococcus) or, more rarely, a fungal infection of the bone. It can occur in any bone in the body, but it most often affects the long bones (leg and arm), vertebral (spine), and bones of the foot. Microbial success in osteomyelitis is due to their ability to form biofilms which inhibit the wound healing process and increases resistance to anti-infective agents. Also, biofilms do not allow easy penetration of antibiotics into their matrix making clinical treatment a challenge. The development of local antibiotic delivery systems that deliver high concentrations of antibiotics to the affected site is an emerging area of research with great potential. Standard treatment includes antibiotic therapy, either locally or systemically and refractory cases of osteomyelitis may lead to surgical intervention and a prolonged course of antibiotic treatment involving placement of antibiotic-doped beads or spacers within the wound site. There are disadvantages with this treatment modality including insufficient mixing of the antibiotic, lack of uniform bead size, resulting in lower antibiotic availability, and limitations on the antibiotics employed. Thus, a method is needed to address biofilm formations in the wound and on the surface of the surgical implants to prevent osteomyelitis. In this study, we show that all antibiotics studied were successfully doped into PMMA and antibiotic-doped 3D printed beads, disks, and filaments were easily printed. The growth inhibition capacity of the antibiotic-loaded PMMA 3D printed constructs was also demonstrated. Local antibiotic delivery systems that provide high antibiotic concentrations is an emerging area of research. A method for 3D printing antibiotic-doped PMMA was developed to prevent and remediate bone infection and biofilm formation. Antibiotics were doped into PMMA and antibiotic-doped 3D printed beads, disks, and filaments were successfully printed. Growth inhibition assays showed the efficacy of antibiotic-loaded PMMA 3D printed constructs in inhibiting bacterial growth.
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van Niekerk AH, Birkholtz FF, de Lange P, Tetsworth K, Hohmann E. Circular external fixation and cemented PMMA spacers for the treatment of complex tibial fractures and infected nonunions with segmental bone loss. J Orthop Surg (Hong Kong) 2018. [PMID: 28639529 DOI: 10.1177/2309499017716242] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the outcome of combined circular external fixation and cemented polymethylmethacrylate (PMMA) spacer application between a cohort of patients with grade 3 open fractures and infected tibial nonunions and concomitant segmental bone loss. METHODS The study was designed as a retrospective cohort study. All patients who were treated for complex tibial fractures or infected nonunions with segmental bone loss between 2009 and 2013 were included if they were aged between 16 years and 60 years, sustained acute traumatic grade 3 open tibial fractures, presented with infected nonunion, and were followed up for a minimum of 12 months. Patients with a history of ipsilateral tibial fractures, contralateral lower extremity fractures, polytrauma, chest, or abdominal trauma and patients with head injuries were excluded. Both groups were treated with aggressive debridement, circular external fixation, and antibiotic-impregnated PMMA spacer. Outcome measures were the time in the external fixator (EFT) and the external fixation index (EFI). RESULTS Twenty-four patients with a mean age of 32 ± 14.7 years were included. Twelve patients with a mean age of 32 + 14 years and a mean bone defect of 82 + 36 mm were treated for acute complex grade 3 open tibial fractures, and 12 patients with a mean age of 35.1 + 15.7 years and a mean bone defect of 50 + 26 mm were treated for infected nonunions. There was no significant difference ( p = 0.44) between the groups for EFT (249 ± 99 days-tibial fractures; 255 ± 142 days-infected nonunion). There were significant between group differences ( p = 0.027) for EFI (37.3 ± 9.1 cm/days-tibial fractures; 56 ± 14.5 cm/days-infected nonunion). CONCLUSION The findings of this study suggest that patients were treated for infected nonunion with segmental bone loss using circular external fixation, distraction osteogenesis, and antibiotic-impregnated PMMA spacers, and the spacers may not offer any advantage over a conventional approach using the principles of osteogenesis only. In contrast, antibiotic-impregnated spacers for open tibial trauma were advantageous and reduced the EFI considerably.
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Affiliation(s)
- Andries H van Niekerk
- 1 Department of Orthopaedic Surgery, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Franz F Birkholtz
- 1 Department of Orthopaedic Surgery, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa.,2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa
| | - Phillip de Lange
- 2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa
| | - Kevin Tetsworth
- 3 Department of Orthopaedic Surgery, Royal Brisbane Hospital, Brisbane, Australia.,4 Queensland University of Technology, Brisbane, Australia.,5 University of Queensland School of Medicine, Brisbane, Australia.,6 Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia
| | - Erik Hohmann
- 2 Walk-a-Mile Centre for Advanced Orthopaedics, Netcare Unitas Hospital, Mediclinic Midstream Hospital, Pretoria, South Africa.,6 Orthopaedic Research Centre of Australia, Brisbane, Queensland, Australia.,7 Medical School, University of Queensland, Queensland, Australia.,8 School of Medicine, University of Pretoria, Pretoria, South Africa
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Anagnostakos K, Fink B. Antibiotic-loaded cement spacers – lessons learned from the past 20 years. Expert Rev Med Devices 2018; 15:231-245. [DOI: 10.1080/17434440.2018.1435270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Bernd Fink
- Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Germany
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Ibrahim MS, Twaij H, Haddad FS. Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study. Bone Joint J 2018; 100-B:3-8. [PMID: 29292333 PMCID: PMC6424436 DOI: 10.1302/0301-620x.100b1.bjj-2017-0626.r1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 07/18/2017] [Indexed: 12/28/2022]
Abstract
Aims Periprosthetic joint infection (PJI) remains a challenging complication
following total hip arthroplasty (THA). It is associated with high
levels of morbidity, mortality and expense. Guidelines and protocols
exist for the management of culture-positive patients. Managing
culture-negative patients with a PJI poses a greater challenge to
surgeons and the wider multidisciplinary team as clear guidance
is lacking. Patients and Methods We aimed to compare the outcomes of treatment for 50 consecutive
culture-negative and 50 consecutive culture-positive patients who
underwent two-stage revision THA for chronic infection with a minimum
follow-up of five years. Results There was no significant difference in the outcomes between the
two groups of patients, with a similar rate of re-infection of 6%,
five years post-operatively. Culture-negative PJIs were associated
with older age, smoking, referral from elsewhere and pre-operative
antibiotic treatment. The samples in the culture-negative patients
were negative before the first stage (aspiration), during the first-stage
(implant removal) and second-stage procedures (re-implantation). Conclusion Adherence to strict protocols for selecting and treating culture-negative
patients with a PJI using the same two-stage revision approach that
we employ for complex culture-positive PJIs is important in order
to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple
A)100-B:3–8.
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Affiliation(s)
- M S Ibrahim
- The Royal London, Whitechapel Road, London, E1 1BB, UK
| | - H Twaij
- Kingston Hospital, Galsworthy Road, London, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK
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45
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Zhou Z, Seta J, Markel DC, Song W, Yurgelevic SM, Yu XW, Ren W. Release of vancomycin and tobramycin from polymethylmethacrylate cements impregnated with calcium polyphosphate hydrogel. J Biomed Mater Res B Appl Biomater 2017; 106:2827-2840. [PMID: 29282858 DOI: 10.1002/jbm.b.34063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 11/08/2017] [Accepted: 12/02/2017] [Indexed: 12/25/2022]
Abstract
The influence of calcium polyphosphate (CPP) gel incorporation on the release of vancomycin and tobramycin from polymethyl methacrylate (PMMA) cement (Simplex P, SP) has been studied. Adding 10% CPP gel to SP led to a much lower burst release of vancomycin and considerably extended release of both vancomycin and tobramycin up to 24 weeks. Antibiotics released from this new material retain their bactericidal activity for up to 15 weeks. The improvement in the antibiotic release is mainly due to the molecular interactions of antibiotics with embedded CPP polyphosphate chains as confirmed by Raman spectroscopy analysis. The inclusion of CPP hydrogel also increased the SP surface roughness and pore sizes, leading to a higher release rate of antibiotics. The new material is biocompatible and has similar handling properties and mechanical strength as compared to SP cements. We believe that incorporating CPP gel provides a better and usable drug carrier for PMMA cement. © 2017 The Authors Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2827-2840, 2018.
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Affiliation(s)
- Zubin Zhou
- Department of Orthopaedics, Shanghai 6th Peoples Hospital, Shanghai, China
| | - Joe Seta
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | - David C Markel
- Department of Orthopedics, Providence Hospital, Southfield, Michigan
| | - Wei Song
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan
| | | | - Xiao Wei Yu
- Department of Orthopaedics, Shanghai 6th Peoples Hospital, Shanghai, China
| | - Weiping Ren
- Department of Orthopaedics, Shanghai 6th Peoples Hospital, Shanghai, China.,Department of Orthopedics, Providence Hospital, Southfield, Michigan
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Tipnis NP, Burgess DJ. Sterilization of implantable polymer-based medical devices: A review. Int J Pharm 2017; 544:455-460. [PMID: 29274370 DOI: 10.1016/j.ijpharm.2017.12.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/29/2017] [Accepted: 12/02/2017] [Indexed: 02/03/2023]
Abstract
This review article is focused on the sterilization techniques used for polymer-based implantable medical devices as well as the regulatory aspects governing sterile medical devices. Polymeric materials are increasingly used in implantable devices due to their biodegradable and biocompatible nature. Patients and medical staff often prefer long-term implantable devices and these can be achieved using high molecular weight polymers. Sterilization of polymer-based implantable devices is critical. Since all implantable devices must be sterile, the effect of the sterilization method on the different device components (such as, the polymer, the drug, the electronics, etc.) has to be considered. A comprehensive summary of the established sterilization methods is provided along with the possible effects on polymers. In addition, novel sterilization methods are also discussed.
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Affiliation(s)
- Namita P Tipnis
- University of Connecticut, Department of Pharmaceutical Sciences, Storrs, CT 06269, United States
| | - Diane J Burgess
- University of Connecticut, Department of Pharmaceutical Sciences, Storrs, CT 06269, United States.
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Al Thaher Y, Perni S, Prokopovich P. Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material. Adv Colloid Interface Sci 2017; 249:234-247. [PMID: 28477865 DOI: 10.1016/j.cis.2017.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022]
Abstract
Total joint replacement (TJR), such as hip and knee replacement, is a popular procedure worldwide. Prosthetic joint infections (PJI) after this procedure have been widely reported, where treatment of such infections is complex with high cost and prolonged hospital stay. In cemented arthroplasties, the use of antibiotic loaded bone cement (ALBC) is a standard practice for the prophylaxis and treatment of PJI. Recently, the development of bacterial resistance by pathogenic microorganisms against most commonly used antibiotics increased the interest in alternative approaches for antimicrobial delivery systems such as nanotechnology. This review summarizes the efforts made to improve the antimicrobial properties of PMMA bone cements using nanotechnology based antibiotic and non-antibiotic delivery systems to overcome drawbacks of ALBC in the prophylaxis and treatment of PJIs after hip and knee replacement.
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Affiliation(s)
- Yazan Al Thaher
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Stefano Perni
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK.
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Efficacy of Target Drug Delivery and Dead Space Reduction Using Antibiotic-loaded Bone Cement for the Treatment of Complex Spinal Infection. Clin Spine Surg 2017; 30:E1246-E1250. [PMID: 28692571 DOI: 10.1097/bsd.0000000000000567] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES We have treated complex cases of surgical site infection (SSI) successfully using antibiotic-loaded bone cement to avoid the need for implant removal. In the present study, we describe a new treatment option for SSI. SUMMARY OF BACKGROUND DATA Although there are several treatment options for SSI after spinal surgery involving instrumentation, several types of problems may arise and are difficult to cure. MATERIALS AND METHODS Eleven patients with SSI after undergoing spinal surgery involving instrumentation were studied. All had been refractory to conventional treatments, including intravenous antibiotic administration and conventional debridement and irrigation. Antibiotic-loaded bone cement was placed on and around the instrumentation to cover them and to occupy the surrounding dead space. Two general types of antibiotics were loaded into the polymethylmethacrylate bone cement. The recipes for the mixture were changed depending on the bacterial cultures. Sensitive antibiotics were administered generally for 2-6 weeks until the C-reactive protein level was normalized. RESULTS All patients were treated successfully using antibiotic-loaded bone cement. Only 1 patient needed a repeat of this procedure to treat an infection. Antibiotic-loaded bone cement was placed in situ in all patients during the follow-up period and there were no significant adverse events. CONCLUSIONS Antibiotic-loaded bone cement treatment reduces the dead space and achieves the targeted drug delivery simultaneously. Treatment using antibiotic-loaded bone cement is an effective treatment option for complex spinal SSI.
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49
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The influence of antibiotic-loaded cement spacers on the risk of reinfection after septic two-stage hip revision surgery. Infection 2017; 45:885-891. [PMID: 29067626 PMCID: PMC5696448 DOI: 10.1007/s15010-017-1081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/11/2017] [Indexed: 01/30/2023]
Abstract
Purpose The aim of this study was the evaluation of possible outcome differences of patients undergoing two-stage hip exchange with antibiotic-loaded spacers, compared to patients without an interim spacer implantation. Methods We evaluated 46 patients undergoing two-stage hip revision surgery. Twenty-five patients received an interim ALS. Additional to a Kaplan–Meier survival analysis, a competing risk analysis was performed to estimate the cumulative incidence function for re-revisions due to infection accounting for death as a competing event. Results Nine patients (seven non-ALS vs. two ALS) had to undergo re-revision surgery due to reinfection of the hip joint. The non-ALS group showed a risk of re-revision of 19% (95% CI 5–38%) at 12 and 24 months and 30% (95% CI 12–51%) at 36 months. The group with ALS implantation displayed a 0% risk of re-revision surgery in the first 36 months. The Gray test revealed a significant difference in the cumulative incidence between both observed groups (p = 0.026). Conclusion Our findings suggest that ALS implantation significantly reduces the risk of reinfection after two-stage hip revision surgery.
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50
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Geller JA, Cunn G, Herschmiller T, Murtaugh T, Chen A. Acute Kidney Injury After First-Stage Joint Revision for Infection: Risk Factors and the Impact of Antibiotic Dosing. J Arthroplasty 2017; 32:3120-3125. [PMID: 28578840 DOI: 10.1016/j.arth.2017.04.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Scarce literature exists regarding risk factors associated with postoperative acute kidney injury (AKI) after first-stage revision procedures. The purpose of this study was to determine risk factors for AKI and the efficacy of intra-articular antibiotics in infection eradication. METHODS We retrospectively identified 247 patients who underwent a 2-stage revision procedure for the treatment of hip or knee periprosthetic joint infection. We applied previously published diagnostic criteria for AKI to determine its incidence and risk factors for its development. RESULTS A 26% incidence of AKI was found after first-stage joint revision for infection. Higher body mass index (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; P = .02), lower baseline hemoglobin level (OR, 0.70; 95% CI, 0.51-0.96; P = .03), and existence of a comorbid condition (OR, 2.67; 95% CI, 1.26-5.64; P = .01) were significant risk factors for AKI. Neither a higher dose of vancomycin (OR, 0.99; 95% CI, 0.88-1.11; P = .83) nor tobramycin (OR, 0.89; 95% CI, 0.77-1.04; P = .15) used in the cement spacer increased the risk of AKI. Each unit increase in vancomycin dose in the cement spacer decreased the odds of failing to clear the infection at 1 and 2 years by a factor of 0.82 (95% CI, 0.70-0.95; P = .01). CONCLUSION AKI after first-stage revision procedures for periprosthetic joint infection occurs more commonly than previously reported. Patients with identified risk factors should be managed carefully with attention paid to hemoglobin levels, to avoid AKI after this procedure. Further research is needed to determine the optimal local antibiotic type and dosing to maximize infection clearance and minimize potential side effects.
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Affiliation(s)
- Jeffrey A Geller
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Medical Center at New York Presbyterian Hospital, New York, New York
| | - Gregory Cunn
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Medical Center at New York Presbyterian Hospital, New York, New York
| | - Thomas Herschmiller
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Medical Center at New York Presbyterian Hospital, New York, New York
| | - Taylor Murtaugh
- Department of Orthopedic Surgery, Center for Hip and Knee Replacement, Columbia University Medical Center at New York Presbyterian Hospital, New York, New York
| | - Antonia Chen
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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