A ceramic bone substitute containing gentamicin gives good outcome in trochanteric hip fractures treated with dynamic hip screw and in revision of total hip arthroplasty: a case series

Abstract

BackgroundThe primary objective was to investigate the clinical and radiological outcome in patients undergoing major hip surgery using a novel antibiotic containing bone substitute for local augmentation in trochanteric fracture fixation or revision of total hip arthroplasty (THA).MethodsWe implanted a novel biphasic bone substitute CERAMENT™|G consisting of hydroxyapatite, calcium sulphate and gentamicin for bone regeneration and local antibiotic delivery in 20 patients treated surgically for trochanteric femoral fracture or uncemented hip revision. Preoperative, postoperative, 3 months and 1 year clinical and radiological assessment were performed including registration of any complications. In one trochanteric fracture patient, histological analyses were performed of bone biopsies taken at removal of hardware.ResultsNone of the trochanteric fractures or revision of THA showed any large migration. No local wound disturbances were seen and no infection was observed at one year follow-up. All trochanteric fractures healed at 3 months with a minimal sliding screw displacement on average 3 mm. Radiological analysis showed signs of bone remodeling and new bone formation in the substitute, illustrated also by histology in the biopsies taken from one trochanteric fracture at one year post-op.ConclusionsLocal CERAMENT™|G was shown to be safe in a limited prospective major hip surgery study. Remodeling of the bone graft substitute was observed in all patients.Trial registrationEU-CTR2018–004414-18 Retrospectively registered on November 20, 2018.

Antibiotic Containing Bone Substitute in Major Hip Surgery: A Long Term Gentamicin Elution Study

“…No loosening of the implants was observed and active integration of the material in the bone healing process could be seen 17 .…”

Combined fracture and mortality risk evaluation for stratifying treatment in hip fracture patients: A feasibility study

“…the degree of osteoporosis, on the other hand is associated with failures. [4] Despite the increase in clinical awareness; adoption of secondary preventation using bisphosphantes is still low, partly due to low patient adherence. [18] Besides, even if included in a dual-energy X-ray absorptiometry surveillance program, there is a delayed response to bisphosphonate treatment, which has been deemed critical, during the first one and half years.…”

“…[5,20] Many different techniques and materials used in fragile bone were described in clinical and in vivo studies as well as in computer models. [4,5] However, data available are scattered. PMMA is today the only approved augmentation material for cannulated and fenestrated screws in the spine and the use has not been widely spread and search for alternative methods continues.…”

“…In a limited one-year followup study, the use of an injectable ceramic applied in the trochanteric fracture bone void has been shown to lead to adequate fracture healing with minimal DHS screw migration. [4] Neither dual X-ray absorptiometry nor quantitative computed tomography (QCT) is an ideal assessment tool measuring bone quality after a hip fracture. On the other hand, volumetric BMD methods with voxel-based morphometry and spatial assessment from QCT images have been validated and applied in hip fracture studies, in a clinical setting with the non-fractured femoral head canal, the tentative screw canal and its surrounding as the region of interest.…”

“…[3] Augmentation of the fractured bone by injection of polymethyl methacrylate (PMMA) or synthetic bone into the femoral neck and trochanter could be of interest to improve the initial stability, particularly in patients with low bone quality, and therefore theoretically reduce the risk of fixation failure. [4,5] Several techniques for augmentation described in tool (FRAX), was introduced in 2008. [6] Fracture Risk Assessment tool provides the clinician with a 10-year probability of a fragility fracture, using basic clinical factors, with or without the use of bone mineral density (BMD) measurement.…”