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[Antibiotic-loaded bone cements: from laboratory studies clinical evaluation]
1Fédération de Chirurgie Orthopédique et Traumatologique, CHU de Rennes 35056 Rennes, France.
Bulletin De L'Academie Nationale De Medecine
|January 18, 2005
Summary
Antibiotic-loaded bone cements (ALBC) effectively treat infected prostheses and prevent infections. Studies confirm high antibiotic levels at infection sites with minimal systemic absorption, ensuring safety and efficacy in hip replacement surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomaterials Science
Context:
- Empirical use of antibiotic-loaded bone cements (ALBC) for infected prostheses and antibioprophylaxis.
- Need for rigorous in vitro, animal, and clinical studies to validate efficacy and safety.
- Total hip replacement (THR) procedures present challenges in infection control and management.
Purpose:
- To evaluate the in vitro and in vivo performance of ALBC.
- To establish the pharmacokinetic profile of gentamicin in ALBC.
- To assess the clinical efficacy of ALBC in treating and preventing infections during THR.
Summary:
- In vitro and animal studies demonstrated gentamicin diffusion from ALBC exceeding minimal inhibitory concentration (MIC).
- Clinical studies showed high periprosthetic fluid antibiotic concentrations (>20x MIC) with negligible blood levels (<1 mg/l).
- ALBC achieved an 85% infection control rate in 342 THR procedures and showed no complications in over 2000 prophylactic cases.
Impact:
- Established experimental methods for evaluating ALBC, paving the way for gentamicin and vancomycin formulations.
- Demonstrated ALBC's benefit in both direct and two-stage THR exchange for moderate to severe infections.
- ALBC offers a safe and effective strategy for infection control in joint replacement, with potential for antibiotic-loaded bone substitutes.