Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

Abstract

Background: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. Scope: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up. Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. Conclusion: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

Biomaterials and technologies in the management of periprosthetic infection after total hip arthroplasty: An updated review

“…The mixture is then added directly to the implant surfaces about 10 min after mixing. [11] In vitro studies showed significant reductions in bacteria adhesions when used on a sterile titanium disc after being coated with the DAC hydrogel. [39] Animal studies showed the efficacy of DAC hydrogel loaded with an antibiotic to prevent implant-related infection without affecting the bone healing or osseointegration of the implants.…”

“…They reported two early failures within the first 3 weeks post-revision surgery; the remaining 26 patients did not show signs of reinfection (clinical and laboratory) at the last follow-up, they also reported no implant loosening or ingrowth failure. [11]…”

“…[10] The strategies for preventing and competing for infection occupy the whole perioperative stages; it starts from the preoperative phase, such as patient optimization and antibiotic prophylaxis administration, some intraoperative strategies including some maneuvers related to the prevention and inhibition of microorganism adhesions to the implants through implant surface modifications such as antibiotic-loaded hydroxyapatite (HA), nanosilver particles, and antiseptic-based coatings, and in the care in postoperative phase by application of proper surgical dressings and watchful wound care. [7,11] The issues related to the pathogenesis of PJI, development and updates in the biomarkers used for detecting PJI, and the various surgical techniques used for PJI eradication, had been reported extensively in the literature; [7,9,12] in this review, we aimed at discussing some of the advancement and updates related to biomaterials and technologies used for managing PJI.…”

Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications

“…While studies demonstrating its efficiency in preventing different types of implant-induced infections exist, studies with a greater number of patients and longer follow-up are lacking. The limitations of this technique are that it enables the addition of a limited amount of antibiotics and its considerable cost [ 184 ]. In addition, the gel-like structure of DAC ® does not provide the mechanical strength and structural stability required for applications in bone repair, causing its unintentional removal during the surgical procedure.…”

Total hip arthroplasty periprosthetic infection management, the dilemma remains

“…Another crucial advancement in the treatment plan is introducing new implant coatings (which have prevention and curative roles); local hydrogel coatings showed their efficacy in preventing infection when used with cementless implants to manage patients diagnosed with chronic PJI with no effect on the implant osteointegration properties. [16] Povidone-iodine was used as a coating for hip implants, which resulted in no infection when implanted in revision cases for PJI. [17] Furthermore, silver nanoparticles were used as coatings, which showed promising results regarding reducing the post-operative incidence of PJI.…”