Experimental study of the application of a new bone cement loaded with broad spectrum antibiotics for the treatment of bone infection

Azuara, G.; García-García, J.; Ibarra, Blanca; Parra-Ruiz, Francisco J.; Asúnsolo, Ángel; Ortega, Miguel A.; Vázquez‐Lasa, Blanca; Buján, Julia; Román, Julio San; Torre, Basilio de la

doi:10.1016/j.recote.2018.10.005

Cited by 7 publications

(13 citation statements)

References 31 publications

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“…The exclusion criteria included, apart from the patients not allergic to metals with Cr-Co TKA (162 TKA in 153 patients), they were the following: patients who underwent TKA for post-traumatic OA and those with previous osteotomies around the knee [ 6 ], deceased patients [ 1 ], those who are not willing to answer the questionnaires [ 3 ] and a patient with two different implants in both knees (Cr-Co and hypoallergenic). 72 hypoallergenic RTAs in 64 patients formed the final sample of the study ( Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…Total knee arthroplasty (TKA) is the definitive treatment for knee osteoarthritis (OA), reducing pain and providing a better quality of life [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. However, 15 to 30% of the patients that undergo TKA, show little or no improvement after surgery [ 6 , 7 , 8 ]. Among other factors, this high percentage is related to the surgical technique and implant selection [ 1 , 2 , 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

Peña

Ortega

Buján

et al. 2021

IJERPH

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The outcome in total knee arthroplasty (TKA) depends on multiples factors, among them is the psychological condition. In addition, up 15 to 30% of the patients that undergo TKA show little or no improvement after surgery, which implies the diagnosis of a painful TKA is a challenge for the orthopedic surgeon, who must rule out a possible metal allergy (MA). It is considered an exclusion diagnosis. Due to the complex relationship between psychological condition and MA, and according to the worse results in patients treated with a hypoallergenic TKA, we asked: (1). What degree of psychological distress (PD) is present in patients who have a hypoallergenic TKA, and how does it influence the results of quality of life (QoL) and functional capacity. (2). Can we develop a new algorithm for patients with a possible MA that improves the outcomes? A pragmatic clinical study was carried out that included patients who underwent hypoallergenic TKA during three consecutive years. Quality of life and functional capacity were measured with (Western Ontario McMaster Universities Osteoarthritis Index) WOMAC index, the Short Form 12 questionnaire (SF-12) questionnaire, and the The EQ-5D-5L questionnaire essentially consists of two pages: the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS) (Euro-QoL-5D L-VAS (EQ5D)), in all patients. To assess PD, a Psychological Distress Score was developed. SPSS software was performed to statistical analysis, and Student´s test for independent variables with a p < 0.005 as statistically significant. A total of 72 anallergic TKAs in 64 patients were treated during this period; 31.3% of these patients showed features of PD before the surgery. According with the severity of the PD, 60% were classified as severe, 10% as moderate and 30% as mild. Patients with PD had statistically significant worse results on the final WOMAC, SF-12, and EQ5D questionnaires. The final scores of the physical subscale of the SF-12 and EQ5D showed better results in patients diagnosed by psychiatrist. Up to one third of the patients with hypoallergenic TKAs have PD, and their results are clearly inferior to those patients with MA without PD. When PD was diagnosed according with Psychological Distress Score, patients should be carefully assessed in order to determine if a specialist referral is recommended. According with our results, PD should be assessed either by the PCP or by us. If the PD is confirmed, a psychiatry referral is then requested for better preoperative management and treatment. We believe that this approach would lead to better TKA outcomes.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

Peña

Ortega

Buján

et al. 2021

IJERPH

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“…Azuara et al [ 91 ] added PLGA into commercial vancomycin or linezolid-containing PMMA cements (Palacos ® R) and tested them in a cemented implant model in rabbits. The authors substituted 45% of the solid phase in the commercial cements with PLGA microspheres and used them to secure S. aureus -contaminated hydroxyapatite rods ( Figure 7 ).…”

Section: Controlling Antibiotic Release From Pmma Cementmentioning

confidence: 99%

“… Surgical procedures: (1,2) insertion of the contaminated rod, (3,4) sealing the defect with bone cement. More extensive bone destruction was observed in the antibiotic-containing PMMA control group ( A ) compared to experimental PLGA-modified antibiotic-containing PMMA ( B ) (Adapted and reprinted with permission from Azuara et al [ 91 ]). …”

Section: Figurementioning

confidence: 99%

Controlling Antibiotic Release from Polymethylmethacrylate Bone Cement

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Nguyen

et al. 2021

Biomedicines

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Bone cement is used as a mortar for securing bone implants, as bone void fillers or as spacers in orthopaedic surgery. Antibiotic-loaded bone cements (ALBCs) have been used to prevent and treat prosthetic joint infections by providing a high antibiotic concentration around the implanted prosthesis. High antibiotic concentrations are, on the other hand, often associated with tissue toxicity. Controlling antibiotic release from ALBCS is key to achieving effective infection control and promoting prosthesis integration with the surrounding bone tissue. However, current ALBCs still need significant improvement in regulating antibiotic release. In this review, we first provide a brief introduction to prosthetic joint infections, and the background concepts of therapeutic efficacy and toxicity in antibiotics. We then review the current state of ALBCs and their release characteristics before focusing on the research and development in controlling the antibiotic release and osteo-conductivity/inductivity. We then conclude by a discussion on the need for better in vitro experiment designs such that the release results can be extrapolated to predict better the local antibiotic concentrations in vivo.

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“…Osteoarthrosis of the knee is a progressive and complex degenerative joint disease that produces chronic pain, reduces mobility, and influences quality of life and work capacity, as well as psychosocial interaction [ 1 , 2 ]. Total knee arthroplasty (TKA) is the final treatment for knee osteoarthritis, reducing pain and improving the quality of life of patients [ 3 , 4 , 5 , 6 , 7 ], but between 15% and 30% of patients who undergo TKA have little or no improvement [ 6 , 7 , 8 ]. This high percentage involves factors related to the surgical technique [ 5 , 8 ], patient characteristics [ 1 , 2 , 9 ], and the selected implant [ 2 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Decrease of Quality of Life, Functional Assessment and Associated Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty

Peña

Ortega

Buján

et al. 2020

JCM

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Total knee arthroplasty (TKA) is the final treatment for knee osteoarthritis, and 15–30% of patients show little or no improvement. This high percentage is related to aspects of the surgical technique, the selected implant, and specific patient characteristics. The aim of this study was to analyze whether there are differences in quality of life (QoL) and functional capacity among patients undergoing TKA with conventional implants compared to those treated with hypoallergenic oxinium implants. A pragmatic clinical study was carried out that included patients who underwent TKA between January 2013 and December 2015. During this period, 245 knees in 228 patients were treated. Eleven patients were excluded, leaving a sample of 161 conventionally treated knees, 72 knees treated with hypoallergenic implants, and one patient who received both implant types. In all patients, QoL and functional capacity were measured with the WOMAC index, the SF-12 questionnaire, and the Euro-Qol-5D L-VAS. We also assessed the psychological distress of each patient and related the findings to the functional results. The differences in QoL were tested using ANCOVA and propensity score matching (PSM) models adjusted for sex, age, weight, psychiatric history and associated complications. Patients who underwent TKA using conventional prostheses had significantly better scores on the total WOMAC index and in the pain domain (p < 0.05) than those who received hypoallergenic prostheses, but no significant differences were observed for the other domains in the ANCOVA. In contrast, with the PSM, we also found statistically significant differences in the difficulty domain of the WOMAC. Significant differences were found for the SF-12 mental health questionnaire results (p = 0.038), but the same did not occur for the physical health domain in the ANCOVA and PSM. We also found statistically significant differences in the Euro-Qol-5D index results (p = 0.041), but not in the VAS scale scores for the same questionnaire in the ANCOVA, and we did not find significant differences in either with the PSM. Patients with metal allergies and those who present psychological distress had WOMAC, SF-12, and Euro-Qol-5D results that were statistically significantly worse than those of patients who received conventional implants. Patients who underwent hypoallergic TKA had lower scores on the QoL and functional capacity scales than patients who received conventional Cr–Co implants. Additionally, patients with psychological distress had worse results on the questionnaires, and those with a metal allergy had even lower scores; the differences were statistically significant.

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Experimental study of the application of a new bone cement loaded with broad spectrum antibiotics for the treatment of bone infection

Cited by 7 publications

References 31 publications

Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

Influence of Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty. Treatment Algorithm for Patients with Metal Allergy and Knee Osteoarthritis

Controlling Antibiotic Release from Polymethylmethacrylate Bone Cement

Decrease of Quality of Life, Functional Assessment and Associated Psychological Distress in Patients with Hypoallergenic Total Knee Arthroplasty

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