Treatment of Periprosthetic Infections: An Economic Analysis

Hernández-Vaquero, Daniel; Fernández-Fairén, Mariano; Torres, Ana; Menzie, A.M.; Fernández-Carreira, José Manuel; Murcia-Mazón, A.; Guerado, Enrique; Merzthal, Luis

doi:10.1155/2013/821650

Cited by 64 publications

(41 citation statements)

References 48 publications

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“…Staphylococcus aureus is responsible for the majority of chronic osteomyelitis cases; and these bone infections remain a major challenge in orthopaedics . Additionally, these infections are considered to be incurable due to biofilm dwelling bacteria that persist within Staphylococcus abscess communities (SACs or Brodie's abscesses) and deep within cortical bone; and costing billions of dollars each year . Of particular concern is the community‐associated methicillin‐resistant S. aureus (MRSA) strain USA300 LAC, which now accounts for the majority of orthopaedic infections .…”

Section: Introductionmentioning

confidence: 99%

“…1 Additionally, these infections are considered to be incurable due to biofilm dwelling bacteria that persist within Staphylococcus abscess communities 2,3 (SACs or Brodie's abscesses 4,5 ) and deep within cortical bone; 6,7 and costing billions of dollars each year. 8 Of particular concern is the communityassociated methicillin-resistant S. aureus (MRSA) strain USA300 LAC, which now accounts for the majority of orthopaedic infections. 9 To address this concern, silicon nitride (Si 3 N 4 ) has emerged as an orthopaedic implant material with remarkable antimicrobial potential compared to standard clinical implants made of stainless steel (SS), poly(aryl-ether-ether-ketone) (PEEK), and titanium (Ti).…”

Section: Introductionmentioning

confidence: 99%

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Surface topography of silicon nitride affects antimicrobial and osseointegrative properties of tibial implants in a murine model

Ishikawa

Bentley

McEntire

et al. 2017

J Biomedical Materials Res

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While silicon nitride (Si3N4) is an antimicrobial and osseosintegrative orthopaedic biomaterial, the contribution of surface topography to these properties is unknown. Using a methicillin-resistant strain of Staphylococcus aureus (MSRA), this study evaluated Si3N4 implants in vitro via scanning electron microscopy (SEM) and colony forming unit (CFU) assays, and later in an established in vivo murine tibia model of implant-associated osteomyelitis. In vitro, the “as-fired” Si3N4 implants displayed significant reductions in adherent bacteria versus machined Si3N4 (2.6×104 vs. 8.7×104 CFU, respectively; p< 0.0002). Moreover, SEM demonstrated that MRSA cannot directly adhere to native “as fired” Si3N4. Subsequently, a cross-sectional study was completed in which sterile or MRSA contaminated “as-fired” and machined Si3N4 implants were inserted into the tibiae of 8-week old female Balb/c mice, and harvested on day 1, 3, 5, 7, 10, or 14 post-op for SEM. The findings demonstrated that the antimicrobial activity of the “as-fired” implants resulted from macrophage clearance of the bacteria during biofilm formation on day 1, followed by osseointegration via the apparent recruitment of mesenchymal stem cells (MSC) on days 3–5, which differentiated into osteoblasts on days 7–14. In contrast, the antimicrobial behavior of the machined Si3N4 was due to repulsion of the bacteria, a phenomenon that also limited osteogenesis, as host cells were also unable to adhere to the machined surface. Taken together, these results suggest that the in vivo biological behavior of Si3N4 orthopaedic implants is driven by critical features of their surface nanotopography.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Surface topography of silicon nitride affects antimicrobial and osseointegrative properties of tibial implants in a murine model

Ishikawa

Bentley

McEntire

et al. 2017

J Biomedical Materials Res

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“…The cost of treating an infected TKA, for example, is three to four times greater than that of treating a noninfected primary TKA and twice that of an aseptic revision. 9 …”

Section: Pji Is a Problem On The Risementioning

confidence: 99%

Periprosthetic joint infection in total knee arthroplasty

Gómez

Parvızı

2015

Current Orthopaedic Practice

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Periprosthetic joint infection (PJI) is currently one of the three main causes of readmission and the most frequent cause of revision following total knee arthroplasty (TKA). It remains the most challenging complication in adult joint reconstruction due to the difficulty in diagnosis and treatment. This review article provides an update on the most recent developments related to the field which include the introduction of a novel biomarker for diagnosis of PJI, a summary of the international consensus meeting on PJI, and other developments.

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“…For patients undergoing tumor megaprosthetic implantation, the risk is greater, estimated at 4% to 45% [28]. This complication harms patients and strains healthcare systems around the world [7,17]. In addition, current treatment for periprosthetic infection such as implant extraction, meticulous débridement, antibioticloaded cement, and high-dose systemic antibiotic administration adds certain morbidity and can often result in side effects without assuring cure [37].…”

Section: Introductionmentioning

confidence: 99%

Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

Norambuena

Patel

Karau

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Periprosthetic infections are devastating for patients and more efficacious preventive strategies are needed. Surface-modified implants using antibacterial coatings represent an option to cope with this problem; however, manufacturing limitations and cytotoxicity have curbed clinical translation. Among metals with antibacterial properties, copper has shown superior in vitro antibacterial performance while maintaining an acceptable cytotoxicity profile. A thin film containing copper could prevent early biofilm formation to limit periprosthetic infections. This pilot study presents the in vitro antibacterial effect, cytotoxicity, and copper ion elution pattern of a thin film of titanium-copper oxide (TiCuO). Questions/purposes (1) Do titanium alloy (Ti6Al4V) discs coated with a thin film of TiCuO reduce Staphylococcus epidermidis biofilm and planktonic cell density compared with uncoated discs? (2) Do Ti6Al4V discs coated with a thin film of TiCuO affect normal human osteoblast viability compared with untreated cells? (3) Is copper ion concentration generated by coated discs lower than previously published copper ion concentrations that cause 50% toxicity in similar human cell lines in vitro (TC50)? Methods Ninety Ti6Al4V discs (12.5 mm diameter; 1.25 mm thick) were used in this study. Seventy-two Ti6Al4V discs were coated with a thin film of either titanium oxide (TiO) or TiCuO containing 20%, 40%, or 80% copper using high-power impulse magnetron sputtering (HiPIMS). Eighteen Ti6Al4V discs remained uncoated for control purposes. We tested antibacterial properties of S epidermidis grown on The institution of one or more of the authors (GAN, RP, MK, CCW, PJJ, KEB, ADH, RJS) has received funding in excess of USD 100,000 from Codelco (Codelco Lab, Santiago, Chile; FP00076314-01-S01) and in excess of USD 10,000 from the Mayo Clinic. With the exception of one of the authors (RJS), the investigators have not personally received any money related to this study. One of the authors certifies that he (RJS), or a member of his immediate family, has received or may receive payments or benefits, during the study period, in an amount of USD 10,000 to USD 100,000 from Biomet Inc (Warsaw, IN, USA Clinical Orthopaedics and Related Research ®A Publication of The Association of Bone and Joint Surgeons® discs in wells containing growth medium. After 24 hours, planktonic bacteria as well as biofilms removed by sonication were quantitatively cultured. Annexin/Pi staining was used to quantify in vitro normal human osteoblast cell viability at 24 hours and Day 7, respectively. Copper elution was measured at Days 1, 2, 3, 7, 14, and 28 using an inductively coupled plasma mass spectrometer to analyze aliquots of culture medium. Copper ion concentration achieved at 24 hours was compared with previously published TC50 for gingival fibroblast, a phenotypically similar cell line with available data regarding copper ion exposure. Results Discs coated with TiCuO 80% copper showed greater biofilm and planktonic cell density re...

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Treatment of Periprosthetic Infections: An Economic Analysis

Cited by 64 publications

References 48 publications

Surface topography of silicon nitride affects antimicrobial and osseointegrative properties of tibial implants in a murine model

Surface topography of silicon nitride affects antimicrobial and osseointegrative properties of tibial implants in a murine model

Periprosthetic joint infection in total knee arthroplasty

Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

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