Current Insights in the Application of Bone Grafts for Local Antibiotic Delivery in Bone Reconstruction Surgery

Abstract

Introduction: Bone implant related infection is still one of the biggest challenges in bone and joint surgery. Antibiotic impregnated bone grafts seem to be promising in both treatment and prevention of these infections. However, great variance in methodology predominates this field of research. This paper gives an overview of the published literature.Methods: The PRISMA-flowchart was used as protocol for article selection. Medline was searched and articles were selected in accordance with predetermined exclusion criteria.Results: Forty-eight articles were included in the synthesis. Topics including bone graft type, manipulations of the graft, elution profile, bacterial inhibition, osteotoxicity, incorporation, special impregnation methods, clinical use and storage were investigated.Therapeutically, high initial levels seem appropriate for biofilm eradication. A single stage procedure in the treatment of bone implant related infection seems feasible. Prophylactically, the literature indicates a reduction of postoperative infections when using antibiotic impregnated bone grafts.Conclusion: Bone grafts are a suitable carrier for local antibiotic application both therapeutically and prophylactically.

Use of Vancomycin Mixed Bone Graft and Vancomycin Mixed Saline Wash Before Wound Closure Reduces the Rate of Infection in Lumbar Spine Fusion Surgery

“…In another study, cancellous grafts impregnated with liquid vancomycin (100mg/ml) reached initial concentrations up to 20,000µg/ml [24]. This is well above the toxic dose of vancomycin described in a study where 10,000µg/ml vancomycin caused osteoblastic cell death, while 1,000µg/ml had no effect [23]. This might be the reason for use of powdered vancomycin in most studies.…”

“…Other disadvantages are the need for a second surgery to remove them and a limited choice of antibiotics to use because of the heat produced during setting. Above problems would be overcome by locally delivering antibiotics through a biodegradable substance, with a suitable elution profile, like bone grafts [23]. Several approaches resulted in high initial antibiotic concentrations, essential for prophylaxis and even biofilm eradication.…”

Protrusio acetabular en artroplastía total de cadera: diez tácticas para un buen resultado quirúrgico

“…La adición de vancomicina en polvo (1 g mezclado con el injerto) pudiera ser una práctica razonable basada en evidencia que no está directamente relacionada a reconstrucciones en protrusio. 47 Ciertamente, queda a discreción del cirujano. Nuestro grupo la ha utilizado en ocasiones en que hemos considerado el caso como de alto riesgo de complicación infecciosa.…”

Fabrication of nanoparticles for bone regeneration: new insight into applications of nanoemulsion technology

“…bone morphogenetic proteins, BMPs [8][9][10] ) and drugs preventing bone resorption, [24][25][26] implant-related infections or inflammation. [16][17][18]21 Drug-loaded nanoparticles can provide controlled sustained drug release over extended periods of time 16,18,21,64 and can be easily introduced into bone defects (e.g. via injection), which may eliminate adverse side effects of drugs administered systemically and current therapeutic approaches to bone injuries based on supra-physiological doses of BMP-2.…”