Abstract
The treatment of implant-related infections is troublesome. This study was conducted to compare the effectiveness of three different surgical modalities in the treatment of implant-related infection. A total of 32 Wistar albino rats were randomised into four groups after the establishment of implant-related infection: no treatment, surgical débridement, antibiotic-loaded bone cement and antibiotic-loaded autogenous bone. Microbiological colony counts were made at the sixth week in order to evaluate the effectiveness of of the treatments. The antibiotic-loaded bone cement group revealed superior results compared with the other groups in terms of reduction of microbiological colonies. Three animals in the bone cement group revealed extensive infection. Although antibiotic-loaded bone cement showed superiority over other treatment modalities, it should be employed after an unsuccessful trial of débridement because of the risk of extensive infection.
Résumé
Le traitement d’implants infectés est difficile. Cette étude a pour but de comparer les effets de trois différents procédés chirurgicaux concernant l’infection associée à des implants. 40 rats albinos Winstar ont été randomisés en quatre groupes après réalisation d’implants infectés: pas de traitement, mise à plat, ciments aux antibiotiques et auto-greffes chargées en antibiotiques locaux. Le comptage des germes et des colonies a été réalisé à la sixième semaine de façon à évaluer l’efficacité des différentes thérapeutiques. le ciment aux antibiotiques se révèle supérieur aux autres groupes en ce qui concerne la réduction du nombre de colonies microbiennes. Trois animaux ont montré une extension de l’infection dans ce groupe ciment aux antibiotiques. bien que le ciment aux antibiotiques montre une supériorité par rapport aux autres modalités thérapeutiques, il faudra le préférer après un essai de mise à plat infructueux de façon à éviter le risque d’une infection généralisée.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Gristina AG, Costerton JW (1985) Bacterial adherence to biomaterials and tissue. The significance of its role in clinical sepsis. J Bone Joint Surg Am 67:264–273
Bauer TW, Schils J (1999) The pathology of total joint arthroplasty. II. Mechanisms of implant failure. Skeletal Radiol 28:483–497
Mader JT, Wang J, Calhoun JH (2001) Antibiotic therapy for musculoskeletal infections. J Bone Joint Surg Am 83:1878–9180
Lau YS, Wang W, Sabokbar A, Simpson H, Nair S, Henderson B, Berendt A, Athanasou NA (2006) Staphylococcus aureus capsular material promotes osteoclast formation. Injury 37(Suppl 2):S41–S48
Hudetz D, Ursic Hudetz S, Harris LG, Luginbühl R, Friederich NF, Landmann R (2008) Weak effect of metal type and ica genes on staphylococcal infection of titanium and stainless steel implants. Clin Microbiol Infect 14(12):1135–1144
Evans RP, Nelson CL (1993) Gentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis. Clin Orthop Relat Res 295:37–42
Zelken J, Wanich T, Gardner M, Griffith M, Bostrom M (2007) PMMA is superior to hydroxyapatite for colony reduction in induced osteomyelitis. Clin Orthop Relat Res 462:190–194
Mendel V, Simanowski HJ, Scholz HC, Heymann H (2005) Therapy with gentamicin-PMMA beads, gentamicin-collagen sponge, and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats. Arch Orthop Trauma Surg 125(6):363–368
Kanellakopoulou K, Giamarellos-Bourboulis EJ (2000) Carrier systems for the local delivery of antibiotics in bone infections. Drugs 59:1223–1232
Kinik H, Karaduman M (2008) Cierny-Mader type III chronic osteomyelitis: the results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics. Int Orthop 32(4):551–558
Günal I, Seber S, Kiraz N, Türkay S, Oztuna V, Gökturk E (1996) In vitro evaluation of antibiotic diffusion from antibiotic impregnated xenografts (in French). Rev Chir Orthop Reparatrice Appar Mot 82(1):59–62
Chen CE, Ko JY, Pan CC (2005) Results of vancomycin-impregnated cancellous bone grafting for infected tibial nonunion. Arch Orthop Trauma Surg 125(6):369–375
Chan YS, Ueng SW, Wang CJ, Lee SS, Chao EK, Shin CH (1998) Management of small infected tibial defects with antibiotic-impregnated autogenic cancellous bone grafting. J Trauma 45(4):758–764
Hsieh PH, Chang YH, Chen SH, Shih CH (2006) Staged arthroplasty as salvage procedure for deep hip infection following intertrochanteric fracture. Int Orthop 30(4):228–232
Tuzuner T, Sencan I, Ozdemir D, Alper M, Duman S, Yavuz T, Yildirim M (2006) In vivo evaluation of teicoplanin- and calcium sulfate-loaded PMMA bone cement in preventing implant-related osteomyelitis in rats. J Chemother 18(6):628–633
Witso E, Persen L, Benum P, Bergh K (2005) Cortical allograft as a vehicle for antibiotic delivery. Acta Orthop 76:481–486
Witso E, Persen L, Benum P, Bergh K (2002) Release of netilmicin and vancomycin from cancellous bone. Acta Orthop Scand 73:199–205
Worlock P, Slack R, Harvey L, Mawhinney R (1988) The prevention of infection in open fractures. An experimental study of the effect of antibiotic therapy. J Bone Joint Surg Am 70(9):1341–1347
Winkler H, Janata O, Berger C, Wein W, Georgopoulos A (2000) In vitro release of vancomycin and tobramycin from impregnated human and bovine bone grafts. J Antimicrob Chemother 46:423–428
Lindsey RW, Probe R, Miclau T, Alexander JW, Peren SM (1993) The effects of antibiotic-impregnated autogeneic cancellous bone graft on bone healing. Clin Orthop Relat Res 291:303–312
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Şener, M., Kazimoglu, C., Karapınar, H. et al. Comparison of various surgical methods in the treatment of implant-related infection. International Orthopaedics (SICOT) 34, 419–423 (2010). https://doi.org/10.1007/s00264-009-0750-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-009-0750-0