2015 Volume No 29 – pages 42-56
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Title: A biodegradable gentamicin-hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses |
Author: D Neut, RJB Dijkstra, JI Thompson, C Kavanagh, HC van der Mei, HJ Busscher |
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Address: Department of Biomedical Engineering (FB40), W.J. Kolff Institute, University of Groningen and University Medical Center Groningen, PO Box 196, 9700 AD Groningen, The Netherlands |
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E-mail: d.neut at umcg.nl |
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Key Words: Cementless prosthesis, gentamicin-releasing coating, hydroxyapatite, antibiotic release, antibacterial efficacy, bone ingrowth. |
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Publication date: January 2nd 2015 |
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Abstract: A degradable, poly (lactic-co-glycolic acid) (PLGA), gentamicin-loaded prophylactic coating for hydroxyapatite (HA)-coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin-loaded cements for fixing traditional, cemented prostheses in bone. We describe the development pathway, from in vitro investigation of antibiotic release and antibacterial properties of this PLGA-gentamicin-HA-coating in different in vitro models to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model. The PLGA-gentamicin-HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance. Gentamicin-sensitive and gentamicin-resistant staphylococci were killed by the antibiotic-loaded coating, in a simulated prosthesis-related interfacial gap. PLGA-gentamicin-HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging. PLGA-gentamicin-HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin. Bone ingrowth to PLGA-gentamicin-HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin-loaded coating. In conclusion, the PLGA-gentamicin-HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses. |
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Article download: Pages
42-56 (PDF file) |
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