Polyurethane: An Old Material for a New Generation of Antibiotic Spacer Implants

IF 1.5 Q3 ORTHOPEDICS Arthroplasty Today Pub Date : 2024-08-09 DOI:10.1016/j.artd.2024.101409
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Abstract

Background

Polyurethane tibial and acetabular inserts that release high concentrations of antibiotics were used with debridement and implant retention to treat prosthetic joint infections. The hypothesis was that a low-friction, antibiotic-releasing bearing could provide a simpler, safer, and more patient-accepted treatment for infection using antibiotic cement and intravenous antibiotics.

Methods

Patients (n = 106) with culture-positive infections received antibiotic inserts. Vancomycin and tobramycin were mixed into the polyurethane polymer at 7% by weight. Contraindications to debridement antibiotics and implant retention were a sinus tract, loose prostheses, and/or the wound could not be closed. Measurable outcomes were success in controlling infection, complications, patient acceptable symptomatic state, and need for revision surgery. Antibiotic levels were measured in joint fluid and blood; laboratory mechanical wear tests were performed; and results were compared to bone cement and polyethylene containing antibiotics.

Results

Antibiotic-infused spacers sustained joint fluid antibiotic levels 8-12 times the therapeutic level and produced low serum levels with no toxicities. Mechanical testing showed low wear and retained mechanical integrity. All patients achieved complication-free remission of infection at a follow-up of 5-26 years. All patients had Harris hip and Knee Society scores above 85, and 68% achieved patient acceptable symptomatic state.

Conclusions

All patients achieved remission of infection, fewer complications compared to revision using antibiotic bone cement, no antibiotic toxicity or adverse drug reactions, and 68% achieved patient acceptance. The antibiotic polyurethane inserts provided antibacterial efficacy comparable with currently used bone cement spacers, and their wear rate was approximately 20 times lower than bone cement as an articulation.

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聚氨酯:新一代抗生素间隔植入物的旧材料
背景将可释放高浓度抗生素的聚氨酯胫骨和髋臼衬垫与清创和植入物固定一起用于治疗假体关节感染。我们的假设是,使用抗生素骨水泥和静脉注射抗生素治疗感染时,低摩擦、释放抗生素的轴承可以提供一种更简单、更安全、更容易被患者接受的治疗方法。万古霉素和妥布霉素以 7% 的重量混入聚氨酯聚合物中。清创抗生素和植入物保留的禁忌症是窦道、假体松动和/或伤口无法闭合。可测量的结果包括感染控制的成功率、并发症、患者可接受的症状状态以及翻修手术的需求。对关节液和血液中的抗生素水平进行了测量;进行了实验室机械磨损测试;并将结果与骨水泥和含有抗生素的聚乙烯进行了比较。机械测试显示,磨损程度低,机械完整性保持良好。所有患者在 5-26 年的随访中均无并发症,感染症状得到缓解。结论与使用抗生素骨水泥进行翻修相比,所有患者均感染缓解,并发症较少,无抗生素毒性或药物不良反应,68%的患者可接受。抗生素聚氨酯插入物的抗菌效果与目前使用的骨水泥垫片相当,其磨损率比骨水泥作为衔接物低约20倍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Arthroplasty Today
Arthroplasty Today Medicine-Surgery
CiteScore
2.90
自引率
0.00%
发文量
258
审稿时长
40 weeks
期刊介绍: Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.
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