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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

  • Nicola Capuano
  • Nicola Logoluso
  • Enrico Gallazzi
  • Lorenzo Drago
  • Carlo Luca Romanò
Knee

Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusions

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

III.

Keywords

Infection PJI One-stage revision Two-stage revision Coating DAC 

Notes

Author contribution

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.

Funding

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.

Ethical approval

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

Informed consent for participation in the study was obtained.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Nicola Capuano
    • 1
  • Nicola Logoluso
    • 2
  • Enrico Gallazzi
    • 2
  • Lorenzo Drago
    • 3
  • Carlo Luca Romanò
    • 2
  1. 1.Department for OrthopaedicsSan Luca HospitalVallo della LucaniaItaly
  2. 2.Department of Reconstructive Surgery of Osteo-articular InfectionsI.R.C.C.S. Galeazzi Orthopaedic InstituteMilanItaly
  3. 3.Laboratory of Clinical Chemistry and MicrobiologyI.R.C.C.S. Galeazzi Orthopaedic InstituteMilanItaly

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