Dataset Information

Individualized Techniques of Implant Coating with an Antibiotic-Loaded, Hydroxyapatite/Calcium Sulphate Bone Graft Substitute.

ABSTRACT: Background:The treatment of fracture- or non-union-related infections has persistently been a major challenge for both patients and treating surgeons. With rising aging of patients and increasing comorbidities, combined with the heterogeneity of germs and any number of multi-resistance against standard antibiotics, a successful treatment is increasingly difficult. One potential solution could be a custom-made individualized antibacterial coating of standard implants with a biphasic degradable biocarrier (Cerament G/V, supplied by Bonesupport AB, Lund, Sweden) that releases high doses of antibiotics around the bone-implant-interface. Here, we describe our technique of coating intramedullary nails, plates and press-fit shoulder endoprostheses which may prevent bacterial adhesion and biofilm formation. So far, there is very limited experience in individual coating of implants in hip or knee endoprostheses to prevent reoccurrence of surgical-site infection. Currently, no reports are available for coating of stems of shoulder prosthesis and nails or plates for fracture fixation. Methods:Here, we show our first experiences with a new individualized surgical technique of coating these implants with a resorbable antibiotic-loaded hydroxyapatite/calcium sulphate biocomposite to prevent biofilm formation and thereby recurrence of bone or joint infection. We describe three cases for coating of plates and nails for fracture fixation and coating of stems of a shoulder prosthesis. Results:No adverse events of the resorbable bone graft substitute were observed. In all of the cases, no recurrence of the infection was observed and osseointegration was achieved. After implant coating of the shoulder prosthesis, no radiological signs of loosening were detected. Conclusion:We present a new surgical approach of a surface coating of plates, intramedullary nails or prostheses. The osteoconductive- and anti-inflammatory effect of the gentamicin- or vancomycin-loaded hydroxyapatite/calcium sulphate bone graft substitutes shows promising results.

SUBMITTER: Freischmidt H

PROVIDER: S-EPMC7425659 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Individualized Techniques of Implant Coating with an Antibiotic-Loaded, Hydroxyapatite/Calcium Sulphate Bone Graft Substitute.

Freischmidt Holger H Armbruster Jonas J Reiter Gregor G Grützner Paul Alfred PA Helbig Lars L Guehring Thorsten T

Therapeutics and clinical risk management 20200729

<h4>Background</h4>The treatment of fracture- or non-union-related infections has persistently been a major challenge for both patients and treating surgeons. With rising aging of patients and increasing comorbidities, combined with the heterogeneity of germs and any number of multi-resistance against standard antibiotics, a successful treatment is increasingly difficult. One potential solution could be a custom-made individualized antibacterial coating of standard implants with a biphasic degra ...[more]

PMID: 32848402

Similar Datasets

Project description:BackgroundIt is unclear whether there is a clinical benefit to adding hydroxyapatite (HA) coatings to total knee implants, especially with the tibial component, where failure of the implant more often occurs. A systematic review of the literature was undertaken to identify all prospective randomized trials for determining whether the overall clinical results (as a function of durability, function, and adverse events) favored HA-coated tibial components.MethodsA comprehensive literature search was performed for the years 1990 to September 16, 2010. We restricted our search to randomized controlled trials involving participants receiving either an HA-coated tibia or other forms of tibial fixation. The primary outcome measures evaluated were durability, function, and acute adverse events.ResultsData from 926 evaluable primary total knee implants in 14 studies were analyzed. Using an RSA definition for durability, HA-coated tibial components (porous or press-fit) without screw fixation were less likely to be unstable at 2 years than porous and cemented metal-backed tibial components (RR = 0.58, 95% CI: 0.34-0.98; p = 0.04, I(2) = 39%, M-H random effects model). There was no significant difference in durability, as measured from revision and evaluated at 2 and 8-10 years, between groups. Also, functional status using different validated measures showed no significant difference at 2 and 5 years, no matter what measure was used. Lastly, there was no significant difference in adverse events. Limitations included small numbers of evaluable patients (≤ 50) in 7 of the 14 trials identified, and a lack of "hard" evidence of durability with need for replacement (i.e. frank failure, pain, or loss of functionality).InterpretationIn patients > 65 years of age, an HA-coated tibial implant may provide better durability than other forms of tibial fixation. Larger trials should be undertaken comparing the long-term durability, function, and adverse events of HA-coated implants with those of other porous-coated tibial implants in younger, more active OA patients.

Project description:BackgroundAseptic loosening is the most frequent indication for revision of total hip arthroplasty. Revision arthroplasty of acetabular component is a challenge for every surgeon because they have to simultaneously deal with the reconstruction of bone defects, adequate implant geometry and stable fixation. Allografts are the most frequently used materials in reconstruction of bone loss during revision surgeries. Because of an increasing number of revision hip arthroplasties and poor availability of allografts, we decided to use bone graft substitutes in acetabular revisions.MethodsBetween September 2005 and January 2010, 44 revision arthroplasties in 43 patients were performed with the use of bone graft substitutes for acetabular defect reconstruction in revision of total hip arthroplasty. Acetabular bone defects were classified according to Paprosky. Seventeen hips were classified as IIA, 3 hips IIB, 3 hips IIC, 10 hips IIIA and 11 hips IIIB. Acetabular bone defects were reconstructed with tricalcium phosphate/hydroxyapatite bone graft substitute - BoneSave. Clinical and radiological examination was performed after 3 months, 1 year and then annually. Harris hip score was used for clinical evaluation. Survival analysis was performed with Kaplan-Meier method with aseptic loosening as the definition of endpoint.ResultsThe average follow-up period is 12 (range from 10 to 15) years. During the follow-up, three patients died after 24 months because of causes not related to surgery. None of the patients was lost to follow-up. The evaluation of clinical results revealed an increase in pre-operative HHS from average 38.3 (range 25 to 55) points to average 86.3 (range 45 to 95) points at the most recent follow-up. Radiographic evaluation showed the migration of one revision cage 12 months after surgery. Revision arthroplasty performed after 14 months revealed the partial incorporation of bone graft substitute. There were not any cases of loosening of revision acetabular cup at the most recent follow up examination in the remaining 39 patients. Bone graft substitute was not absorbed in all of these patients. The survival after 10 years amounted to 97.56%.ConclusionBone graft substitute Bone Save may be suitable for acetabular revision surgery, however preoperative bone defect is critical for success and determining of a surgical technique, so this is multifactorial in this challenge surgery.

Project description:Hydroxyapatite (HA)-coated metals are biocompatible composites, which have potential for various applications for bone replacement and regeneration in the human body. In this study, we proposed the design of biocompatible, flexible composite implants by using a metal mesh as substrate and HA coating as bone regenerative stimulant derived from a simple sol-gel method. Experiments were performed to understand the effect of coating method (dip-coating and drop casting), substrate material (titanium and stainless steel) and substrate mesh characteristics (mesh size, weave pattern) on implant's performance. HA-coated samples were characterized by X-ray diffractometer, transmission electron microscope, field-emission scanning electron microscope, nanoindenter, polarization and electrochemical impedance spectroscopy, and biocompatibility test. Pure or biphasic nanorod HA coating was obtained on mesh substrates with thicknesses varying from 4.0 to 7.9 μm. Different coating procedures and number of layers did not affect crystal structure, shape, or most intense plane reflections of the HA coating. Moduli of elasticity below 18.5 GPa were reported for HA-coated samples, falling within the range of natural skull bone. Coated samples led to at least 90% cell viability and up to 99.5% extracellular matrix coverage into a 3-dimensional network (16.4% to 76.5% higher than bare substrates). Fluorescent imaging showed no antagonistic effect of the coatings on osteogenic differentiation. Finer mesh size enhanced coating coverage and adhesion, but a low number of HA layers was preferable to maintain open mesh areas promoting extracellular matrix formation. Finally, electrochemical behavior studies revealed that, although corrosion protection for HA-coated samples was generally higher than bare samples, galvanic corrosion occurred on some samples. Overall, the results indicated that while HA-coated titanium grade 1 showed the best performance as a potential implant, HA-coated stainless steel 316 with the finest mesh size constitutes an adequate, lower cost alternative.

Dataset Information

Individualized Techniques of Implant Coating with an Antibiotic-Loaded, Hydroxyapatite/Calcium Sulphate Bone Graft Substitute.

Publications

Individualized Techniques of Implant Coating with an Antibiotic-Loaded, Hydroxyapatite/Calcium Sulphate Bone Graft Substitute.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets