Dmitry Gil1,2, Ali E Atici1,3, Rachel L Connolly1, Shannon Hugard1, Sergey Shuvaev2, Keith K Wannomae1, Ebru Oral1,2, Orhun K Muratoglu4,5. 1. Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA. 2. Harvard Medical School, Harvard University, Boston, Massachusetts, USA. 3. Department of Chemistry, Hacettepe University, Ankara, Turkey. 4. Harris Orthopaedic Laboratory, Massachusetts General Hospital. 5. Harvard Medical School, Harvard University.
Abstract
AIMS: We propose a state-of-the-art temporary spacer, consisting of a cobalt-chrome (CoCr) femoral component and a gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial insert, which can provide therapeutic delivery of gentamicin, while retaining excellent mechanical properties. The proposed implant is designed to replace conventional spacers made from bone cement. METHODS: Gentamicin-loaded UHMWPE was prepared using phase-separated compression moulding, and its drug elution kinetics, antibacterial, mechanical, and wear properties were compared with those of conventional gentamicin-loaded bone cement. RESULTS: Gentamicin-loaded UHMWPE tibial components not only eradicated planktonic Staphylococcus aureus, but also prevented colonization of both femoral and tibial components. The proposed spacer possesses far superior mechanical and wear properties when compared with conventional bone cement spacers. CONCLUSION: The proposed gentamicin-eluting UHMWPE spacer can provide antibacterial efficacy comparable with currently used bone cement spacers, while overcoming their drawbacks. The novel spacer proposed here has the potential to drastically reduce complications associated with currently used bone cement spacers and substantially improve patients' quality of life during the treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):151-157.
AIMS: We propose a state-of-the-art temporary spacer, consisting of a cobalt-chrome (CoCr) femoral component and a gentamicin-eluting ultra-high molecular weight polyethylene (UHMWPE) tibial insert, which can provide therapeutic delivery of gentamicin, while retaining excellent mechanical properties. The proposed implant is designed to replace conventional spacers made from bone cement. METHODS:Gentamicin-loaded UHMWPE was prepared using phase-separated compression moulding, and its drug elution kinetics, antibacterial, mechanical, and wear properties were compared with those of conventional gentamicin-loaded bone cement. RESULTS:Gentamicin-loaded UHMWPE tibial components not only eradicated planktonic Staphylococcus aureus, but also prevented colonization of both femoral and tibial components. The proposed spacer possesses far superior mechanical and wear properties when compared with conventional bone cement spacers. CONCLUSION: The proposed gentamicin-eluting UHMWPE spacer can provide antibacterial efficacy comparable with currently used bone cement spacers, while overcoming their drawbacks. The novel spacer proposed here has the potential to drastically reduce complications associated with currently used bone cement spacers and substantially improve patients' quality of life during the treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):151-157.
Entities:
Keywords:
Bone cement; Gentamicin; Prosthetic joint infections; Spacer; Total knee arthroplasty; UHMWPE
Authors: Tim Nichol; Jill Callaghan; Robert Townsend; Ian Stockley; Paul V Hatton; Christine Le Maitre; Thomas John Smith; Robert Akid Journal: Bone Joint J Date: 2021-03 Impact factor: 5.082