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Periprosthetic Joint Infections pp 125–132Cite as

Local Antibiotic Therapy: Non–cement-based Antibiotic Delivery Methods

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Abstract

Bone and soft tissue infections are serious problems that can result in significant morbidity that affects patients drastically. Peri-prosthetic infections are difficult to treat and eradicate. Single-stage revision in the form of surgical debridement with retention or exchange of artificial components, or two-stage revision followed by antibiotic administration remain the main stay of treatment. Delivery of antibiotics within the cement mantle has become popular in providing high local levels to treat infection. However, mixing high concentrations of antibiotics to cement affects its porosity and stiffness, thus predisposing loosening at the cement-implant interface. In addition, most drug elution occurs within hours, making it difficult to be above the minimum inhibitory concentration of bacteria until infection is completely treated. This raises the need to develop biodegradable delivery carriers that are able to release high levels of local antibiotics for long periods of time and eventually disintegrate into the system, preventing the need for secondary procedures to remove them. This chapter discusses different systems present that are currently used to treat bone and peri-prosthetic infections. Ongoing research is required to develop these local antibiotics delivery systems to allow them to replace long-term systemic antibiotics with their associated complications and toxicity.

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Acknowledgements

The author would like to thank EUSA Pharma for providing the Collatamp sample, and Journal of Orthopaedic Surgery (Hong Kong) for granting permission for re-use of figures.

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Authors and Affiliations

  1. Department of Orthopaedics and Trauma, Great Ormond Street Hospital, London, UK

    Moataz El-Husseiny MBBCh,MRCS,Dip Sport M,MD(Res)

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  1. Moataz El-Husseiny MBBCh,MRCS,Dip Sport M,MD(Res)
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Correspondence to Moataz El-Husseiny MBBCh,MRCS,Dip Sport M,MD(Res) .

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Editors and Affiliations

  1. HELIOS ENDO-Klinik Hamburg, Berlin, Germany

    Daniel Kendoff

  2. University Hospital of Wales, Cardiff, United Kingdom

    Rhidian Morgan-Jones

  3. University College London Hospitals, London, United Kingdom

    Fares S. Haddad

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El-Husseiny, M. (2016). Local Antibiotic Therapy: Non–cement-based Antibiotic Delivery Methods. In: Kendoff, D., Morgan-Jones, R., Haddad, F. (eds) Periprosthetic Joint Infections. Springer, Cham. https://doi.org/10.1007/978-3-319-30091-7_10

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  • DOI: https://doi.org/10.1007/978-3-319-30091-7_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30089-4

  • Online ISBN: 978-3-319-30091-7

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