Antibiotic-Loaded Hydrogel Coating to Reduce Early Postsurgical Infections in Aseptic Hip Revision Surgery: A Retrospective, Matched Case-Control Study

Abstract

Periprosthetic joint infections (PJIs) are a cause of frequent implant failure in revision hip replacement surgery. The purpose of this study is to evaluate the onset of early postoperative infections in patients who underwent hip surgery with cementless prostheses treated with an antibiotic loaded hydrogel on their surface, in addition to systemic prophylaxis, and compare them to a control group. The secondary objective was to evaluate the onset of any local and systemic adverse effects and interference with bone ingrowth processes and functional recovery. A retrospective observational study was conducted on patients who underwent revision hip surgery by performing a 1:1 match between patients treated with an antibiotic hydrogel (ALH) and the control patients. The incidence of PJIs was assessed with a minimum of six months follow-up. Seventeen patients treated with the ALH were compared with 17 patients from the control group. No PJIs were reported in the ALH group versus the six cases encountered in the control group (p < 0.0001). No significant differences were reported with regard to prosthetic osseointegration and functional results, nor were there side effects in the ALH group. Despite the low sample size, the use of on-site prophylaxis with ALH has proven effective and safe in reducing the risk of PJIs in patients with a high risk for infections. Further studies are needed to validate these results in other implant-related surgeries.

Gentamicin-Coated Tibia Nail in Fractures and Nonunion to Reduce Fracture-Related Infections: A Systematic Review

“…At the time of writing, the only coatings available on the market for clinical uses are: preloaded gentamicin-coated nail, antibiotic-loaded hydrogel, silver-coated prosthesis, and iodine-coated implants. Antibiotic-loaded hydrogel has been studied both in joint replacement surgery [ 27 ] and in trauma surgery [ 28 ]; it has been proven to be effective and safe. Compared to the gentamicin PDLLA nail coating, the hydrogel has some advantages.…”

Clinical Application of Antibacterial Hydrogel and Coating in Orthopaedic and Traumatology Surgery

“…This study was later supported by other evidence in the literature that confirm its effectiveness. A previous study shows that, in patients who underwent a cementless revision due to aseptic failure of the hip replacement, the incidence of infection was the main cause of short-term failure and that the application of the gel drastically reduces this occurrence ( p = 0.0001) [ 18 ]. In cases of uncemented implants, the use of the gel in revisions and re-interventions represents an important reduction in the infectious risk ( Figure 1 ).…”

Surface coating of orthopedic implant to enhance the osseointegration and reduction of bacterial colonization: a review

“…No significant difference observed in function and prosthetic osseointegration De Meo. et al [ 104 ], 2020 Silver antimicrobial coating An in-vitro study of nano-Ag-loaded coating on Ti-implant to analyse the biological performance of the coating Inhibits bacterial colonization, enhances the proliferation and cell growth around the implant site Zhang et al [ 105 ], 2018 The study evaluates the effectivity of antimicrobial multilayer silver coating techniques that includes the in vivo experiment in which rabbits have methicillin-sensitive S.epidermidis (MSSE) coated in K-wire inserted for 7 days and are scarified for clinical analysis With the significant enhancement in bacterial inhibition, silver multilayer-coated (SML) implants were free of pathogens and no silver was detected in blood proving the SML coating more effective in combating bacterial infection in implants Fabritius et al [ 106 ], 2020 …”

“…Figure 2 illustrates the experiment on “Antibacterial loaded hydrogel coating on final implant” De Meo, et al [ 104 ] reveals that an implant coated with an antibiotic has a significant effect on bacterial inhibition. The implants were coated immediately before the insertion and divided into two groups.…”

“…Antibiotic loaded hydrogel (ALH) insertion with 5 ml of hydrogel mixed with 200 mg of gentamicin total of 14 patients; and 2). Dual antibiotic loaded hydrogel with 250 mg of vancomycin mixed with 5 ml of hydrogel and 200 mg of gentamicin in four patients [ 104 ].

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