Addressing prosthetic joint infections via gentamicin-eluting UHMWPE spacer

Abstract

Aims We propose a state-of-the-art temporary spacer, consisting of a cobalt-chrome (CoCr) femoral component and a gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial insert, which can provide therapeutic delivery of gentamicin, while retaining excellent mechanical properties. The proposed implant is designed to replace conventional spacers made from bone cement. Methods Gentamicin-loaded UHMWPE was prepared using phase-separated compression moulding, and its drug elution kinetics, antibacterial, mechanical, and wear properties were compared with those of conventional gentamicin-loaded bone cement. Results Gentamicin-loaded UHMWPE tibial components not only eradicated planktonic Staphylococcus aureus, but also prevented colonization of both femoral and tibial components. The proposed spacer possesses far superior mechanical and wear properties when compared with conventional bone cement spacers. Conclusion The proposed gentamicin-eluting UHMWPE spacer can provide antibacterial efficacy comparable with currently used bone cement spacers, while overcoming their drawbacks. The novel spacer proposed here has the potential to drastically reduce complications associated with currently used bone cement spacers and substantially improve patients’ quality of life during the treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):151–157.

Periprosthetic joint infection: what next?

“…38 Biomaterial modifications such as new sol-gel technology which release gentamycin from the implant, gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial inserts, and silver coating of implants have all been proposed as techniques for reducing the rate of PJI but have their limitations. [39][40][41] The development and implementation of a Staphylococcus aureus vaccine has been challenging, but it may become a promising prophylactic strategy for PJI in the future.…”

Irradiation Behavior of Analgesic and Nonsteroidal Anti-Inflammatory Drug-Loaded UHMWPE for Joint Replacement

“…Blending drugs into UHMWPE leads to a decrease of the tensile strength, ductility and toughness , with increasing concentration (Table , Table S14 and Figure S18). Compositions with tolfenamic acid showed the lowest decrease in mechanical properties compared to virgin UHMWPE, presumably due to the hydrophobicity of this drug, which may enhance interfacial adhesion with or some solubility in the UHMWPE matrix.…”

The efficacy of antibiotic‐eluting material in a two‐stage model of periprosthetic joint infection

“…For the control groups, there was also some bacteria observed on the polyethylene in the femur whereas there was no bacteria on the GPE implant, suggesting a resistance to implant colonization. GPE are expected to elute gentamicin in a similar manner with a Fickian diffusion profile 20 and the intra‐articular concentration of gentamicin is dependent on this elution profile and the clearance of gentamicin from the local tissues. The effect of the gentamicin concentration on the bacteria would be expected to be similar in terms of inhibition or eradication.…”

“…18 We have shown that vancomycin and gentamicin can be incorporated into UHMWPE without loss of function and can be eluted at concentrations above the minimum inhibitory concentrations of S. aureus for several weeks. 19,20 Thus, the objective of the current study was two-fold: the first was to establish a two-stage revision procedure expanding our previous PJI model, which established but did not treat PJI. The second was to evaluate the model by using an antibiotic-eluting polyethylene in the setting of liner exchange, which constitutes an adverse scenario.…”

“…In addition to systemic antibiotics, 17 the most common local antibiotics in antibiotic‐eluting bone cement spacers are the aminoglycosides gentamicin/tobramycin and the glycopeptide vancomycin 18 . We have shown that vancomycin and gentamicin can be incorporated into UHMWPE without loss of function and can be eluted at concentrations above the minimum inhibitory concentrations of S. aureus for several weeks 19,20 …”