Abstract
Chronic periprosthetic joint infection (PJI) is a devastating complication that requires an aggressive eradication protocol. Local antimicrobial delivery via dissolvable calcium sulfate (CaSO) using small-sized beads (3–8 mm) has been utilized as an adjunctive treatment combined with implant exchange, radical debridement, and antimicrobial loaded acrylic spacers. The non-exothermic setting of CaSO theoretically allows for any antimicrobial agent to be used, so long as mixing methods provide a consistent fabrication within a reasonable set time. This study performed the first in vitro mixing study, in which various antimicrobial agents, used singularly and in combination, were mixed with a synthetic CaSO product to observe and document their interactions. The study was performed in a simulated operating room environment. We report a standard mix formula with set times, testing 22 different antimicrobial agents, combinations, and doses. For some antimicrobials and combinations, set times using the standard formula were either too fast or exceedingly slow. For these 14 antimicrobial agents and combinations, we were able to arrive at individualized mixing methods. We present all mixing formulas and set times. In all, we were able to establish mixing methods that incorporate all antimicrobial agents and combinations that we have seen utilized via surgeon-directed use.
Highlights
Joint replacement surgery for degenerative arthrosis provides improved function and pain relief in the majority of cases where this procedure is utilized (Merx et al, 2003; Lohmander et al, 2006; Lützner et al, 2011; Maradit Kremers et al, 2015)
This paper reports our work with a mixing study whereby, in a laboratory setting, we mixed antimicrobial agents into a synthetic, commercially pure CaSO4 product, creating a dissolvable antimicrobial bead
When encountering difficulty in mixing specific antimicrobial agents, we developed modified mixing techniques to create an antimicrobial-loaded bead that previously was problematic with our standard technique
Summary
Joint replacement surgery for degenerative arthrosis provides improved function and pain relief in the majority of cases where this procedure is utilized (Merx et al, 2003; Lohmander et al, 2006; Lützner et al, 2011; Maradit Kremers et al, 2015). Adverse responses do occur at relatively low rates (McPherson et al, 2020). Such risks include fixation failure, mechanical dysfunction, fracture, reactive wear debris phenomenon, and infection. Of these complications, that which stands out as the most problematic is periprosthetic joint infection (PJI). That which stands out as the most problematic is periprosthetic joint infection (PJI) This is due to the difficulty in eradicating the infection, as well as the enormous impact placed upon the patient and healthcare system (Kurtz et al, 2008, 2012; Costerton et al, 1999, 2005). Further complicating matters is the extended use of parenteral antimicrobial agents, which disrupts numerous human physiologic systems, confers human biome resistance, and affects future treatment options (Levast et al, 2021)
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