Effect of Antibiotic Prophylaxis on Surgical Site Infections Following Removal of Orthopedic Implants Used for Treatment of Foot, Ankle, and Lower Leg Fractures

Backes, Manouk; Dingemans, Siem A.; Dijkgraaf, Marcel G. W.; Berg, Hannah; Dijkman, B. van; Hoogendoorn, J. M.; Joosse, Pieter; Ritchie, Ewan D.; Roerdink, W.H.; Schots, Judith P M; Sosef, Nico L.; Spijkerman, Ingrid J. B.; Twigt, Bas A; Veen, A.H. van der; Veen, Ruben N van; Vermeulen, Jefrey; Vos, Dagmar; Winkelhagen, Jasper; Goslings, J. Carel; Schepers, Tim

doi:10.1001/jama.2017.19343

Cited by 46 publications

(36 citation statements)

References 37 publications

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“…In our series, 29 patients (including 32 surgical sites) received the elective implant removal surgery, and only 1 case was complicated with surgery-related wound problem (the other 2 cases were related to chronic osteomyelitis). The wound complication rate was 3%, which was comparable to the surgical site infection rate of clean surgery (2%) [ 17 ] and much less than orthopedic implant removal surgery ever reported (12.2 to 20%) [ 9 , 11 , 18 ].…”

Section: Discussionmentioning

confidence: 81%

A novel implant removal technique by endoscopy

et al. 2018

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BackgroundRoutine implant removal after fracture healing remains controversial. However, it has been suggested that implant removal should be performed in cases of joint impingement, painful scar adhesion, and implant malposition. Entrance selection is relatively critical in patients with poor soft tissue conditions or sloughing coverage. We propose an innovative technique using endoscopy.MethodsConsecutive surgeries of endoscopic implant removal performed between 2005 and 2016 by a single experienced arthroscopic surgeon were included. Overall, 73 patients were enrolled; 44 were not eligible for inclusion and were excluded from the study.ResultsTwenty-nine patients, including 32 surgical sites, were included. Twenty-four plates and 166 screws were removed using this technique. There were five complications during the follow-up period (range, 0.5 to 104 months; mean, 8.8), including one broken screw, one persistent knee joint contracture, and three wound dehiscence. There were no infections or neurovascular injuries.ConclusionImplant removal using endoscopy is a minimally invasive surgery that ensures that the screw axis does not strip, and treats the intra-articular pathology concomitantly. This innovative technique may be considered as an alternative to the traditional open method in cases with good surgical indications.

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Section: Discussionmentioning

confidence: 81%

A novel implant removal technique by endoscopy

et al. 2018

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“…Prophylactic use of antibiotics in orthopedic surgeries includes a single preoperative dose and a possible re-dosing 24 or 48 hours after the operation. 26,27 In a similar manner to prophylactic antibiotic use, Gao et al demonstrated that the majority of silver from 70 nm AgNP on the surface of a PEEK implant were released within 24 hours, yielding a 5 lg/mL extract; the cumulative silver release curve plateaued after 5 days. 28 A reduction in viability of MC3T3-E1 osteoblast precursor cells was observed, but this difference versus the control was eliminated by day 5 due to dilution of the silver with repeated media changes.…”

Section: Discussionmentioning

confidence: 98%

Effects of Subcytotoxic Exposure of Silver Nanoparticles on Osteogenic Differentiation of Human Bone Marrow Stem Cells

NguyenAlexander

PatelReema

NobleJade

et al. 2019

Applied In Vitro Toxicology

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Introduction: In vitro toxicology evaluations utilizing human stem cell models represent attractive alternatives to conventional animal models, which are not always predictive of human responses. Silver nanoparticles (AgNP) are a potent antimicrobial for use in orthopedic devices. However, AgNP exposure may alter the behavior of stem cells within the bone marrow. The aim of this study was to determine if differences in cell proliferation, early, and late osteogenic differentiation markers can be detected in osteogenically differentiating human bone marrow mesenchymal stem cells (hBMSC) over a 21-day period at AgNP concentrations that are not considered cytotoxic after 24-hour exposure per ISO 10993-5 cytotoxicity testing guidelines. Materials and Methods: Polyvinylpyrrolidone (PVP)-coated 10 nm AgNP were evaluated for their short-term (24-hour) cytotoxicity to hBMSC using the MTT assay to determine subcytotoxic concentrations for the subsequent long-term study investigating osteogenic differentiation. hBMSC were exposed to 1, 5, or 10 lg/mL AgNP in three different exposure scenarios: single (24-hour), repeated (24-hour at 1, 7, and 14 days), or continuous (21day) exposure. Alkaline phosphatase (early osteogenic differentiation marker), hydroxyapatite deposition (late marker), and cell proliferation were measured at days 1, 7, 14, and 21. Results: AgNP exposure reduced cell proliferation for all treatments. Neither differentiation marker expression was observed at any timepoint in hBMSC exposed to AgNP at 10 lg/mL for any exposure scenario or in cells exposed to 5 lg/mL in the repeated or continuous exposure scenarios. Conclusions: Differences in proliferation and osteogenic marker expression were detected in the different exposure scenarios at AgNP concentrations identified as subcytotoxic in a 24-hour exposure assay.

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“…Interestingly, a randomized clinical trial showed that a single preoperative dose of intravenous cefazolin, compared with placebo saline solution, did not reduce the risk of SSI within 30 days of the elective removal of hardware used for the treatment of foot, ankle, and lower-leg fractures 94 .…”

Section: Orthopaedic Traumamentioning

confidence: 99%