Ashley E Levack1, Erika L Cyphert2, Mathias P Bostrom1, Christopher J Hernandez1,3,4, Horst A von Recum5, Alberto V Carli1,6. 1. Hospital for Special Surgery, New York, NY, USA. 2. Department of Biomedical Engineering, Case Western Reserve University, Room 220 Wickenden Building, 10900 Euclid Avenue, Cleveland, OH, 44106, USA. 3. Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY, USA. 4. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA. 5. Department of Biomedical Engineering, Case Western Reserve University, Room 220 Wickenden Building, 10900 Euclid Avenue, Cleveland, OH, 44106, USA. Hav1@case.edu. 6. Surgery, The Ottawa Hospital, Ottawa, ON, Canada.
Abstract
PURPOSE OF REVIEW: Infection in the setting of total joint arthroplasty, referred to as periprosthetic joint infection (PJI), is a devastating complication requiring prolonged and costly treatment. The unique environment around an artificial joint and ability of surrounding tissues to sequester bacteria collectively make prevention, diagnosis, and treatment of this condition challenging. In light of the unique pathogenesis of PJI, this review explores the limitations of contemporary treatments and discusses novel treatment options. RECENT FINDINGS: Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.
PURPOSE OF REVIEW: Infection in the setting of total joint arthroplasty, referred to as periprosthetic joint infection (PJI), is a devastating complication requiring prolonged and costly treatment. The unique environment around an artificial joint and ability of surrounding tissues to sequester bacteria collectively make prevention, diagnosis, and treatment of this condition challenging. In light of the unique pathogenesis of PJI, this review explores the limitations of contemporary treatments and discusses novel treatment options. RECENT FINDINGS: Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.
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