One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection
Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI).
In this two-center case–control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating.
At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6 days, respectively).
Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections.
Level of evidence
KeywordsInfection PJI One-stage revision Two-stage revision Coating DAC
NC and CLR were involved in study design, data collection, results interpretation and writing the manuscript. NL, EG and LD were involved in data collection, results interpretation and reviewing of the manuscript.
The authors report no financial support.
Compliance with ethical standards
Conflict of interest
CLR has received consulting fees from Novagenit Srl. The other authors declare that they have no conflict of interest.
All investigations were conducted in conformity with ethical principles of research and institutional approval of the human protocol for this investigation was obtained.
Informed consent for participation in the study was obtained.
- 3.Boot W, Gawlitta D, Nikkels PG, Pouran B, van Rijen MH, Dhert WJ, Vogely HC (2017) Hyaluronic acid-based hydrogel coating does not affect bone apposition at the implant surface in a rabbit model. Clin Orthop Relat Res. https://doi.org/10.1007/s11999-017-5310-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Boot W, Vogely HCH, Nikkels PGJ, Pouran B, van Rijen M, Dhert WJA, Gawlitta D (2015) Local prophylaxis of implant-related infections using a hydrogel as carrier. Eur Cells Mat 30(2):19–20Google Scholar
- 7.Carlsson AS, Egund N, Gentz CF, Hussenius A, Josefsson G, Lindberg L (1985) Radiographic loosening after revision with gentamicin-containing cement for deep infection in total hip arthroplasties. Clin Orthop Relat Res 194:271–279Google Scholar
- 13.Garvin KL, Evans BG, Salvati EA, Brause BD (1994) Palacos gentamicin for the treatment of deep periprosthetic hip infections. Clin Orthop Relat Res 298:97–105Google Scholar
- 14.George DA, Logoluso N, Castellini G, Gianola S, Scarponi S, Haddad FS et al (2016) Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review. BMC Inf Dis 16(1):553–566CrossRefGoogle Scholar
- 29.Malizos K, Blauth M, Danita A, Capuano N, Mezzoprete R, Logoluso N, Drago L, Romanò CL (2017) Fast-resorbable antibiotic-loaded hydrogel coating to reduce post-surgical infection after internal osteosynthesis: a multicenter randomized controlled trial. J Orthop Traum. https://doi.org/10.1007/s10195-017-0442-2 CrossRefGoogle Scholar
- 30.Malizos K, Scarponi S, Simon K, Blauth M, Romanò C (2015) Clinical results of an anti-bacterial hydrogel coating of implants: a multi-centre, prospective, comparative study. Bone Joint J 97-B(16):138–139Google Scholar
- 37.Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson AR (2013) Infectious diseases society of America. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious diseases society of America. Clin Infect Dis 56(1):1–10CrossRefGoogle Scholar
- 51.Wroblewski BM (1986) One-stage revision of infected cemented total hip arthroplasty. Clin Orthop Relat Res 211:103–107Google Scholar