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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

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

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.

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Funding

The authors report no financial support.

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Authors and Affiliations

  1. Department for Orthopaedics, San Luca Hospital, Vallo della Lucania, Italy

    Nicola Capuano

  2. Department of Reconstructive Surgery of Osteo-articular Infections, I.R.C.C.S. Galeazzi Orthopaedic Institute, Via R. Galeazzi 4, 20161, Milan, Italy

    Nicola Logoluso, Enrico Gallazzi & Carlo Luca Romanò

  3. Laboratory of Clinical Chemistry and Microbiology, I.R.C.C.S. Galeazzi Orthopaedic Institute, Milan, Italy

    Lorenzo Drago

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  1. Nicola Capuano
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Contributions

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.

Corresponding author

Correspondence to Carlo Luca Romanò.

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CLR has received consulting fees from Novagenit Srl. The other authors declare that they have no conflict of interest.

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All investigations were conducted in conformity with ethical principles of research and institutional approval of the human protocol for this investigation was obtained.

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Capuano, N., Logoluso, N., Gallazzi, E. et al. 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. Knee Surg Sports Traumatol Arthrosc 26, 3362–3367 (2018). https://doi.org/10.1007/s00167-018-4896-4

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