Addressing prosthetic joint infections via gentamicin-eluting UHMWPE spacer

Aims We propose a state-of-the-art temporary spacer, consisting of a cobalt-chrome (CoCr) femoral component and a gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial insert, which can provide therapeutic delivery of gentamicin, while retaining excellent mechanical properties. The proposed implant is designed to replace conventional spacers made from bone cement. Methods Gentamicin-loaded UHMWPE was prepared using phase-separated compression moulding, and its drug elution kinetics, antibacterial, mechanical, and wear properties were compared with those of conventional gentamicin-loaded bone cement. Results Gentamicin-loaded UHMWPE tibial components not only eradicated planktonic Staphylococcus aureus, but also prevented colonization of both femoral and tibial components. The proposed spacer possesses far superior mechanical and wear properties when compared with conventional bone cement spacers. Conclusion The proposed gentamicin-eluting UHMWPE spacer can provide antibacterial efficacy comparable with currently used bone cement spacers, while overcoming their drawbacks. The novel spacer proposed here has the potential to drastically reduce complications associated with currently used bone cement spacers and substantially improve patients’ quality of life during the treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):151–157.

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Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics

Journal of Orthopaedics and Traumatology ◽

10.1186/s10195-021-00607-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Giuseppe Basile ◽

Mario Gallina ◽

Alberto Passeri ◽

Rosa Maria Gaudio ◽

Nicolò Castelnuovo ◽

...

Keyword(s):

Risk Management ◽

Imaging Techniques ◽

Developed Countries ◽

Joint Infections ◽

Systemic Antibiotic Therapy ◽

Prosthetic Joint ◽

Management Procedures ◽

Prosthetic Joint Infections ◽

The Right

AbstractProsthetic joint infections (PJI) represent one of the major problems in orthopedic prosthetic surgery. The incidence of PJIs varies according to the site of intervention, and different published case studies report occurrence at 0.5 to 3.0% in the event of first implants, with a significant greater risk in the case of prosthesis revisions. The diagnosis of prosthetic infections is seldom simple, needing a multi-specialist approach, which includes the accurate collection of patient anamnesis, its clinical evaluation, the evaluation of inflammation biomarkers, and the use of imaging techniques. It is essential to identify the bacteria responsible for the infection not only for an accurate diagnosis, but also to select the correct antibiotic treatment. Failure to identify the bacteria involved makes it impossible to establish targeted systemic antibiotic therapy. In developed countries such as Italy, the right to health is guaranteed by the Constitution, where the institutions that provide health services must be staffed by a team of medical professionals that can guarantee the safest possible health pathways. Risk management represents the set of actions aimed at improving the quality of the care provided, the adherence to guidelines and good care practices with the final objective of guaranteeing patients’ safety. All hospitals, including the ones where prosthetic orthopedic surgery is performed, must adopt clinical risk management procedures which, through prospective tools aimed at preventing errors and complications and by retrospective methods, permit the identification of critical points in the different phases of the process and propose actions for improvement. The constant increase in litigation for malpractice in Western countries, especially in Italy, calls for special attention to the problem of PJIs and the in-depth assessment of medico-legal problems, also considering the new legislative initiatives in the field of medical malpractice. Hospitals need to tackle the onset of PJIs in a transparent and linear fashion by constantly informing the patient on their progress.

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A novel modified acrylic bone cement matrix. A step forward on antibiotic delivery against multiresistant bacteria responsible for prosthetic joint infections

Materials Science and Engineering C ◽

10.1016/j.msec.2014.02.002 ◽

2014 ◽

Vol 38 ◽

pp. 218-226 ◽

Cited By ~ 28

Author(s):

Ana C. Matos ◽

Lídia M. Gonçalves ◽

Patrícia Rijo ◽

Mário A. Vaz ◽

António J. Almeida ◽

...

Keyword(s):

Bone Cement ◽

Cement Matrix ◽

Acrylic Bone Cement ◽

Joint Infections ◽

Prosthetic Joint ◽

Multiresistant Bacteria ◽

Prosthetic Joint Infections ◽

Antibiotic Delivery

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Controlling Antibiotic Release from Polymethylmethacrylate Bone Cement

Biomedicines ◽

10.3390/biomedicines9010026 ◽

2021 ◽

Vol 9 (1) ◽

pp. 26

Author(s):

Victoria Wall ◽

Thi-Hiep Nguyen ◽

Nghi Nguyen ◽

Phong A. Tran

Keyword(s):

Bone Cement ◽

Joint Infections ◽

Current State ◽

Prosthetic Joint ◽

Prosthetic Joint Infections ◽

Antibiotic Release ◽

Local Antibiotic ◽

Bone Void

Bone cement is used as a mortar for securing bone implants, as bone void fillers or as spacers in orthopaedic surgery. Antibiotic-loaded bone cements (ALBCs) have been used to prevent and treat prosthetic joint infections by providing a high antibiotic concentration around the implanted prosthesis. High antibiotic concentrations are, on the other hand, often associated with tissue toxicity. Controlling antibiotic release from ALBCS is key to achieving effective infection control and promoting prosthesis integration with the surrounding bone tissue. However, current ALBCs still need significant improvement in regulating antibiotic release. In this review, we first provide a brief introduction to prosthetic joint infections, and the background concepts of therapeutic efficacy and toxicity in antibiotics. We then review the current state of ALBCs and their release characteristics before focusing on the research and development in controlling the antibiotic release and osteo-conductivity/inductivity. We then conclude by a discussion on the need for better in vitro experiment designs such that the release results can be extrapolated to predict better the local antibiotic concentrations in vivo.

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