Abstract
The number of total joint replacements (TJR) is on the rise with a corresponding increase in the number of infected TJR, which necessitates revision surgeries. Current treatments with either non-biodegradable, antibiotic-releasing polymethylmethacrylate (PMMA) based bone cement, or systemic antibiotic after surgical debridement do not provide effective treatment due to fluctuating antibiotic levels at the site of infection. Here, we report a biodegradable, easy-to-use “press-fitting” antibiotic-releasing bone void filling (ABVF) putty that not only provides efficient antibiotic release kinetics at the site of infection but also allows efficient osseointegration. The ABVF formulation was prepared using poly (d,l-lactide-co-glycolide) (PLGA), polyethylene glycol (PEG), and polycaprolactone (PCL) as the polymer matrix, antibiotic vancomycin, and osseointegrating synthetic bone PRO OSTEON for bone-growth support. ABVF was homogenous, had a porous structure, was moldable, and showed putty-like mechanical properties. The ABVF putty released vancomycin for 6 weeks at therapeutic level. Furthermore, the released vancomycin showed in vitro antibacterial activity against Staphylococcus aureus for 6 weeks. Vancomycin was not toxic to osteoblasts. Finally, ABVF was biodegradable in vivo and showed an effective infection control with the treatment group showing significantly higher bone growth (p < 0.001) compared to the control group. The potential of infection treatment and osseointegration makes the ABVF putty a promising treatment option for osteomyelitis after TJR.
Highlights
In the United States over a million people undergo total joint replacements (TJR) each year [1,2,3]
The current study evaluated the in vitro vancomycin release and in vivo potential of antibiotic-releasing bone void filling (ABVF) putty to be used to treat osteomyelitis, demonstrating antibacterial protection, moldability, biodegradability, as well as osseointegration and healing of local bone tissue
Scanning Electron Microscopy (SEM) images show that ABVF has a rough outer surface (Figure 1a) while the inner surface has both macro and micro porous structures (Figure 1a)
Summary
In the United States over a million people undergo total joint replacements (TJR) each year [1,2,3]. This number is projected to exceed 4 million primary procedures each year by 2030 [2]. TJRs, including total knee replacements (TKR) and total hip replacements (THR), are arguably some of the most successful surgical practices to improve the quality of life, secondary or revision surgeries are becoming commonplace. With the success of TJRs, primary TJR procedures are occurring at an earlier age [4,5], often necessitating a revision during the patient’s lifetime as the prosthetic TJR materials age. Implant age, and infection are major contributors to the rate of revision
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