Abstract
BackgroundImplant-related osteomyelitis (IRO) is recently controlled with local antibiotic delivery systems to overcome conventional therapy disadvantages. In vivo evaluation of such systems is however too little.Questions/purposesWe asked whether vancomycin (V)-containing poly-l-lactic acid/β-tricalcium phosphate (PLLA/β-TCP) composites control experimental IRO and promote bone healing in vivo.MethodsFifty-six rats were distributed to five groups in this longitudinal controlled study. Experimental IRO was established at tibiae by injecting methicillin-resistant Staphylococcus aureus (MRSA) suspensions with titanium particles in 32 rats. Vancomycin-free PLLA/β-TCP composites were implanted into the normal and infected tibiae, whereas V-PLLA/β-TCP composites and coated (C)-V-PLLA/β-TCP composites were implanted into IRO sites. Sham-operated tibiae established the control group. Radiological and histological scores were quantified with microbiological findings on weeks 1 and 6.ResultsIRO is resolved in the CV- and the V-PLLA/β-TCP groups but not in the PLLA/β-TCP group. MRSA was not isolated in the CV- and the V-PLLA/β-TCP groups at all times whereas the bacteria were present in the PLLA/β-TCP group. Radiological signs secondary to infection are improved from 10.9 ± 0.9 to 3.0 ± 0.3 in the V-PLLA/β-TCP group but remained constant in the PLLA/β-TCP group. Histology scores are improved from 24.7 ± 6.5 to 17.6 ± 4.8 and from 27.6 ± 7.9 to 32.4 ± 8.9 in the CV-PLLA/β-TCP and the V-PLLA/β-TCP groups, respectively. New bone was formed in all the PLLA/β-TCP group at weeks 1 and 6.ConclusionsCV- and V-PLLA/β-TCP composites controlled experimental IRO and promoted bone healing.Clinical relevanceCV- and V-PLLA/β-TCP composites have the potential of controlling experimental IRO and promoting bone healing.
Highlights
Clinical relevance: CV- and V-PLLA/β-TCP composites have the potential of controlling experimental Implant-related osteomyelitis (IRO) and promoting bone healing
Implant-related osteomyelitis (IRO) [1] is a complex bone infection that requires the surgical removal of sequester or implant [2] followed with the debridement of the infected tissues [3] and high dosage antibiotic regimen for 6 weeks [4]
We asked whether CV- and V-PLLA/β-TCP composites controlled experimental IRO and promoted bone healing in vivo
Summary
Implant-related osteomyelitis (IRO) [1] is a complex bone infection that requires the surgical removal of sequester or implant [2] followed with the debridement of the infected tissues [3] and high dosage antibiotic regimen for 6 weeks [4]. Staphylococcus aureus is the main causative organism for osteomyelitis [5] It can form a biofilm, an extracellular polymeric matrix, in which cells can communicate and protect themselves from antibacterial agents [6]. PLLA slowed vancomycin release and β-TCP aided mesenchymal stem and Saos-2 bone cells attachment, proliferation, and differentiation in vitro [17]. This composite was further dip coated (C) with PLLA and 63.1% and 91.9% of the vancomycin released on days 1 and 42, respectively. We asked whether CV- and V-PLLA/β-TCP composites controlled experimental IRO and promoted bone healing in vivo. Questions/purposes: We asked whether vancomycin (V)-containing poly-l-lactic acid/β-tricalcium phosphate (PLLA/β-TCP) composites control experimental IRO and promote bone healing in vivo
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