Medicated hydrogels of hyaluronic acid derivatives for use in orthopedic field

Pitarresi, Giovanna; Palumbo, Fabio Salvatore; Calascibetta, Filippo; Fiorica, Calogero; Stefano, Mauro Di; Giammona, Gaetano

doi:10.1016/j.ijpharm.2013.03.059

Cited by 68 publications

(54 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding is in line with previous data from in vivo and clinical studies [26,27,34]. The high biocompatibility of its basic constituents and the short time (\3 days) needed for complete hydrogel resorption [22,25] make the possible occurrence of longer term side-effects unlikely.…”

Section: Discussionsupporting

confidence: 90%

“…Biocompatible hydrogels have been shown to be able to deliver pharmacological agents locally and can be designed to meet the desired elution pattern [21]. Recently, a fast-resorbable hydrogel coating that can be loaded intra-operatively with various antibacterials has been developed [22]. Based on the observation that bacterial colonization occurs within the first hours after implant and that short-term systemic prophylaxis is equally effective as long-term to prevent postsurgical infections [23], this coating technology introduced for the first time the concept of 'short-term local protection' of the implant.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

Luca

Kostantinos

Blauth

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

View full text Add to dashboard Cite

Background Infection is one of the main reasons for failure of orthopedic implants. Antibacterial coatings may prevent bacterial adhesion and biofilm formation, according to various preclinical studies. The aim of the present study is to report the first clinical trial on an antibioticloaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC Ò ) to prevent surgical site infection, in patients undergoing internal osteosynthesis for closed fractures. Materials and methods In this multicenter randomized controlled prospective study, a total of 256 patients in five European orthopedic centers who were scheduled to receive osteosynthesis for a closed fracture, were randomly assigned to receive antibiotic-loaded DAC or to a control group (without coating). Pre-and postoperative assessment of laboratory tests, wound healing, clinical scores and X-rays were performed at fixed time intervals.Results Overall, 253 patients were available with a mean follow-up of 18.1 ± 4.5 months (range 12-30). On average, wound healing, clinical scores, laboratory tests and radiographic findings did not show any significant difference between the two groups. Six surgical site infections (4.6%) were observed in the control group compared to none in the treated group (P \ 0.03). No local or systemic side-effects related to the DAC hydrogel product were observed and no detectable interference with bone healing was noted. Conclusions The use of a fast-resorbable antibiotic-loaded hydrogel implant coating provides a reduced rate of postsurgical site infections after internal osteosynthesis for closed fractures, without any detectable adverse event or side-effects. Level of evidence 2.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

Luca

Kostantinos

Blauth

et al. 2017

Revue de Chirurgie Orthopédique et Traumatologique

View full text Add to dashboard Cite

show abstract

“…Consistent with previous in vivo studies 26, 28, our data show that use of the hydrogel coating is clinically safe and devoid of any detectable local or systemic side effects in the short-term follow-up. The biocompatibility of the hydrogel basic components and the short time to resorption 19, 22 make the possible occurrence of delayed side effects quite unlikely. Also, our results showed a ten-fold reduction in the occurrence of early SSIs in the treated patients as compared with the controls.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a fast-resorbable hydrogel coating that works as a physical barrier to bacterial adhesion and that can be intra-operatively loaded with various antibacterials has been developed 22. Based on the observation that bacterial colonization, from microbial adhesion to an established mature biofilm layer, only takes few hours 23 and given the known efficacy of short-term systemic antibiotic prophylaxis 24, a fast-resorbable antibacterial coating may provide “short-term local protection”, while limiting possible long-term unwanted side effects 25.…”

Section: Introductionmentioning

confidence: 99%

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Cl¹,

Malizos

Capuano³

et al. 2016

J. Bone Joint Infect.

View full text Add to dashboard Cite

Background: Infection remains among the main reasons for joint prosthesis failure. Preclinical reports have suggested that antibacterial coatings of implants may prevent bacterial adhesion and biofilm formation. This study presents the results of the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) in patients undergoing hip or knee prosthesis.Methods: In this multicenter, randomized prospective study, a total of 380 patients, scheduled to undergo primary (n=270) or revision (n=110) total hip (N=298) or knee (N=82) joint replacement with a cementless or a hybrid implant, were randomly assigned, in six European orthopedic centers, to receive an implant either with the antibiotic-loaded DAC coating (treatment group) or without coating (control group). Pre- and postoperative assessment of clinical scores, wound healing, laboratory tests, and x-ray exams were performed at fixed time intervals.Results: Overall, 373 patients were available at a mean follow-up of 14.5 ± 5.5 months (range 6 to 24). On average, wound healing, laboratory and radiographic findings showed no significant difference between the two groups. Eleven early surgical site infections were observed in the control group and only one in the treatment group (6% vs. 0.6%; p=0.003). No local or systemic side effects related to the DAC hydrogel coating were observed, and no detectable interference with implant osteointegration was noted.Conclusions: The use of a fast-resorbable, antibiotic-loaded hydrogel implant coating can reduce the rate of early surgical site infections, without any detectable adverse events or side effects after hip or knee joint replacement with a cementless or hybrid implant.

show abstract

“…Based on HA antiadhesive properties, a novel HA-based hydrogel has been recently proposed, in order to protect implanted biomaterials in orthopaedics, trauma and dental surgery from bacterial colonization 42; this fast-resorbable hydrogel coating, composed of covalently linked hyaluronan and poly-D,L-lactide (“Defensive Antibacterial Coating”, DAC ® , Novagenit Srl, Mezzolombardo, Italy), has been found to have a synergistic antibiofilm activity with various antibacterials and able to be effectively manually spread onto the surface of various biomaterials commonly used in orthopaedics, trauma and dental surgery 43 (Fig. 1).…”

Section: Anti-adhesive and Anti-biofilm Properties Of Hyaluronic Acidmentioning

confidence: 99%

Hyaluronic Acid and Its Composites as a Local Antimicrobial/Antiadhesive Barrier

Romanò¹,

Vecchi

Bortolin

et al. 2017

J. Bone Joint Infect.

111

View full text Add to dashboard Cite

Living in biofilms is probably the most common condition for bacteria and fungi and biofilm-related infections account for the majority of bacterial infectious diseases worldwide.Among others biofilm-related infections, those associated with implanted biomaterials have an enormous and still largely underestimated impact in orthopaedics and trauma, cardio-surgery and several other surgical disciplines.Given the limited efficacy of existing antibiotics in the prevention and treatment of bacterial biofilms, new strategies are needed to protect implants and host tissues, overcoming the striking ability of the microorganisms to adhere on different surfaces and to immediately protect themselves by forming the biofilm matrix.Adhesion is a necessary first step in microbial colonization and pathogenesis and provides a potential target for new preventive and treatment approach.Among various polymers, tested as antibacterial coatings, hyaluronic acid and some of its composites do offer a well-established long-term safety profile and a proven ability to reduce bacterial adhesion and biofilm formation.Aim of the present review is to summarize the available evidence concerning the antiadhesion/antibiofilm activity of hyaluronic acid and some of its derivatives to reduce/prevent bacterial adhesion and biofilm formation in various experimental and clinical settings.

show abstract

Medicated hydrogels of hyaluronic acid derivatives for use in orthopedic field

Cited by 68 publications

References 13 publications

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

Fast-resorbable antibiotic-loaded hydrogel coating to reduce postsurgical infection after internal osteosynthesis: A multicenter randomized controlled trial

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Hyaluronic Acid and Its Composites as a Local Antimicrobial/Antiadhesive Barrier

Contact Info

Product

Resources

About