Iontophoresis of antibiotics into segmental allografts

Khoo, Paul; Michalak, Katarzyna; Yates, Piers; Megson, S.M.; Day, Robert E.; Wood, David

doi:10.1302/0301-620x.88b9.17500

Cited by 20 publications

(21 citation statements)

References 80 publications

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“…Two prospective cohort and one randomized trial were classified as level II evidence, whereas the remaining seven reports performed retrospective chart reviews or cohort studies (level III evidence) (Galia et al 2009; Guo et al 2012; Khoo et al 2006; Krasny et al 2013; Pruss et al 2002). Using the GRADE assessment, the quality of clinical studies according to the objectives was found to range from very low to high.…”

Section: Resultsmentioning

confidence: 99%

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Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

et al. 2016

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Musculoskeletal allografts are typically disinfected using antibiotics, irradiation or chemical methods but protocols vary significantly between tissue banks. It is likely that different disinfection protocols will not have the same level of microorganism kill; they may also have varying effects on the structural integrity of the tissue, which could lead to significant differences in terms of clinical outcome in recipients. Ideally, a disinfection protocol should achieve the greatest bioburden reduction with the lowest possible impact on tissue integrity. A systematic review of three databases found 68 laboratory and clinical studies that analyzed the microbial bioburden or contamination rates of musculoskeletal allografts. The use of peracetic acid–ethanol or ionizing radiation was found to be most effective for disinfection of tissues. The use of irradiation is the most frequently published method for the terminal sterilization of musculoskeletal allografts; it is widely used and its efficacy is well documented in the literature. However, effective disinfection results were still observed using the BioCleanse™ Tissue Sterilization process, pulsatile lavage with antibiotics, ethylene oxide, and chlorhexidine. The variety of effective methods to reduce contamination rate or bioburden, in conjunction with limited high quality evidence provides little support for the recommendation of a single bioburden reduction method.Electronic supplementary materialThe online version of this article (doi:10.1007/s10561-016-9584-3) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…The source of the infection was not stated. One was resolved by treatment with antibiotics, and another required amputation (Khoo et al 2006). The GRADE quality of the clinical evidence was low to moderate.…”

Section: Resultsmentioning

confidence: 99%

Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

et al. 2016

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“…These capacities make them more attractive for local therapy and allow using uncemented implants. If cortical bone should become preferable out of whatever circumstances it can be loaded with antibiotics as well [21]. Using adequate impregnation techniques antibiotics may elute in a similarly effective way as with cancellous bone [22].…”

Section: Discussionmentioning

confidence: 99%

“…The groups of Michalak and Khoo tried to increase concentrations of gentamicin and flucloxacillin, respectively, inside segmental allografts by using iontophoresis. Although the reported antibiotic concentrations in drainage fluid were inferior to those presented in combination with purely cancellous grafts, none of the patients became re-infected after implantation of the iontophoresed segmental grafts [20,21]. However, all groups have used the grafts only in the second stage of a two-stage revision after resolution of clinical, laboratory and radiological evidence of sepsis.…”

Section: Introductionmentioning

confidence: 99%

One-stage revision of septic hip prosthesis with antibiotic-loaded bone grafts and cementless implants

Winkler¹

2009

LO SCAL

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Infection of total hip replacement (THR) is a serious complication, necessitating its complete removal and thorough debridement of the site. Usually long-term antibiotic treatment and a multitude of surgical interventions within a period of several months are required until a definitive supply can be achieved. One-stage exchange using antibiotic containing cement did not gain widespread use because of several risks, although the possible clinical and economic advantages are evident. Allograft bone may be impregnated with high loads of antibiotics using a special technique and acts as a carrier, avoiding the disadvantages of cement. Based on this technology 37 exchange procedures of infected THR were performed in a single stage, all of them without the use of bone cement. Three hips required re-revision because of re-infection, the remaining 34 hips (92%) stayed infection-free and stable for a period between 2 and 8 years after surgery. No adverse side effects could be found. Incorporation appeared as after grafting with unimpregnated grafts. Antibiotic impregnated allograft bone may enable reconstruction of bone stock, insertion of an uncemented implant and control of infection in a single operation.

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“…Buttaro et al (23) favorably used vancomycin supplemented cancellous grafts for reconstruction after infected THA (20,23 (24,25). However, all these groups used antibiotic impregnated grafts only in the second stage of a two-stage revision, after resolution of clinical and laboratory evidence of infection.…”

Section: Justificationmentioning

confidence: 99%

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Six)

Parvızı¹,

Ghazavi²,

Meeting³

2016

Shafa Ortho J

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Context: There is a need to find the recommended perioperative antibiotic prophylaxis for current MRSA carriers and to determine if patients with prior history of MRSA should be re-screened and what should the choice of perioperative prophylactic antibiotics be in these patients. There is also a need to determine the recommended prophylaxis in patients undergoing major orthopaedic reconstructions for either tumor or non-neoplastic conditions using megaprosthesis or allograft. Evidence Acquisition: Delegates in workgroup 3 of the consensus meeting on PJI reviewed English literature for relevant articles. 30 of 221 articles were relevant to the 4 following questions regarding perioperative antibiotic prophylaxis to prevent PJI. Results: For current MRSA carriers, vancomycin or teicoplanin is the recommended perioperative antibiotic prophylaxis. Patients with prior history of MRSA should be re-screened preoperatively. If patients are found to be negative for MRSA, we recommend routine perioperative antibiotic prophylaxis. Until the emergence of further evidence, we recommend the use of routine antibiotic prophylaxis for patients undergoing major reconstructions such as allograft or megaprostheses. Conclusions: Based on evidences in the literature and consensus of expert delegates from consensus meeting recommendations for type of antibiotic prophylaxis in patients who are current MRSA carriers, the protocol for screening and type of prophylactic antibiotics for patients with prior history of MRSA and antibiotic prophylaxis for patients undergoing major reconstructions such as megaprosthesis and allograft were provided.

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Iontophoresis of antibiotics into segmental allografts

Cited by 20 publications

References 80 publications

Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

Disinfection of human musculoskeletal allografts in tissue banking: a systematic review

One-stage revision of septic hip prosthesis with antibiotic-loaded bone grafts and cementless implants

Antibiotic Prophylaxis in Periprosthetic Joint Infection (PJI): Literature Review and World Consensus (Part Six)

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