Extracorporeal shockwave increases the effectiveness of systemic antibiotic treatment in implant‐related chronic osteomyelitis: Experimental study in a rat model

Abstract

Implant-related chronic osteomyelitis is a serious complication of orthopedic surgery requiring implant removal and radical debridement. Extracorporeal shockwave (ESW) have demonstrated significant bactericidal effectiveness in vitro and effectiveness and safety were evaluated in an animal model of osteomyelitis. In this experimental study, we aimed to test our hypothesis that the use of ESW together with systemic antibiotic treatment will provide synergy for the treatment of implant-related chronic osteomyelitis caused by methicillin-susceptible Staphylococcus aureus (MSSA). The proximal tibia of 32 rats was contaminated with 10 8 CFU/ml methicillinsensitive S. aureus (MSSA-ATCC 29213) and Kirschner-wires were placed into the medulla of the tibia. After 4 weeks, Kirschner-wires were removed and the rats were randomly divided into four groups: group I, untreated contaminated control group; group II, receiving only ESW therapy; group III, receiving only systemic teicoplanin; group IV, treated with a combination of ESW and systemic teicoplanin. ESW was applied twice to the infected limbs and all rats were sacrificed at the end of 8th week. The degree of tibial osteomyelitis was assessed by quantitative culture analysis. Bacterial counts in groups III and IV were significantly reduced relative to the control (p ¼ 0.002 and 0.001, respectively). The decrease in bacterial counts was more pronounced and significant in group IV compared to group III (p ¼ 0.024). In group II, bacterial counts also decreased, but the differences were in significant (p ¼ 0.068). Our experimental model suggests that ESW provides significant synergy for systemic antibiotic treatment. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of implant-related chronic osteomyelitis in rats. ß

Increased Effects of Extracorporeal Shock Waves Combined with Gentamicin against Staphylococcus aureus Biofilms In Vitro and In Vivo

“…Wang et al (2014) reported that high-energy ESWs can exert favorable bactericidal effects if a suitable impulse rate is selected. Inanmaz et al (2014) reported that ESWs could be a valuable adjunct in the management of chronic implant-related osteomyelitis and that these waves acted in synergy with systemic antibiotic treatment; however, they concluded that further in vitro studies were required to determine the optimal treatment conditions. Horn et al (2009b) confirmed that ESWs can result in a significant reduction of CFUs when bacteria were treated in solution, but no in vivo study was conducted.…”

“…Various studies have been conducted that indicate that ESWs have bactericidal effects under appropriate conditions when combined with anti-biofilm therapy in vitro or in vivo (Horn et al 2009a;Inanmaz et al 2014). Wang et al (2014) reported that high-energy ESWs can exert favorable bactericidal effects if a suitable impulse rate is selected.…”

“…Most studies to date have investigated the effects of antibacterial treatment, rather than the effects of ESW treatment, on antibacterial biofilms (Horn et al 2009a(Horn et al , 2009bInanmaz et al 2014). In the present study, we found that the combination of high-energy ESWs with gentamicin has more potent effects on biofilms formed by S. aureus both in vitro and in vivo, compared with treatment with either ESWs or gentamicin alone.…”

“…Positive effects on bone infections have been observed in a rabbit model, and the effects were energy dependent, with a significant reduction of bacteria at higher energy flux densities of 0.96 mJ/mm 2 . Inanmaz et al (2014) reported that the use of ESWs together with systemic antibiotic treatment had a synergetic effect in the treatment of implant-related chronic osteomyelitis in rats. However, it is not clear whether a combination of ESWs and antimicrobial agents could exert effective bactericidal effects by inhibiting biofilm function.…”

Modern Physical Methods of Stimulating the Bone Tissue Healing Processes

“…Серед ефектів ЕУХТ відзначають: сприяння неоваскуляризації внаслідок активації судинноендотеліального фактору росту з наступною пролі-ферацією ендотеліальних клітин [13,20]; індукцію остеогенетичних факторів росту, таких як трансформуючий фактор росту бета-1 та кісткових морфогенетичних білків, що ініціює активність остеобластів [13,19,21]; зниження больового синдрому [14,22]; зменшення набряку [23]. Відповідно до цього, низкою дослідників були сформульовані наступні показання до застосування ЕУХТ у щелепно-лицевій ділянці: лінійні переломи кісток, зокрема неконсолідовані [24,25]; пародонтит [20,26]; імплантація, зокрема лікування периімплантитів [27]; захворювання скронево-нижньощелепного суглоба [28].…”