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Dual-analgesic loaded UHMWPE exhibits synergistic antibacterial effects against Staphylococci

Dmitry Gil1,2, Shannon Hugard1, Nikolay Borodinov3

  • 1Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts, USA.

Journal of Biomedical Materials Research. Part B, Applied Biomaterials
|December 3, 2022
PubMed

Insights

Dual-analgesic loaded ultra-high molecular weight polyethylene (UHMWPE) shows enhanced antibacterial activity against common joint infection bacteria. This novel material offers improved prophylaxis to reduce periprosthetic joint infection (PJI) rates after total joint arthroplasty.

Area of Science:

  • Biomaterials Science
  • Infectious Disease Research
  • Orthopedic Surgery

Background:

  • Total joint arthroplasty is a common procedure with a significant risk of periprosthetic joint infections (PJI).
  • Current prophylactic measures may not be sufficient to prevent PJIs, leading to severe complications.
  • Antibacterial agents incorporated into ultra-high molecular weight polyethylene (UHMWPE) have shown promise.

Purpose of the Study:

  • To develop and evaluate dual-analgesic loaded UHMWPE for enhanced antibacterial prophylaxis.
  • To assess the efficacy of bupivacaine/tolfenamic acid-loaded UHMWPE against Staphylococcus aureus and Staphylococcus epidermidis.
  • To investigate the relationship between drug elution, material properties, and antibacterial activity.

Main Methods:

  • Preparation of bupivacaine/tolfenamic acid co-loaded UHMWPE implants.
  • Assessment of antibacterial activity against Staphylococcus aureus and Staphylococcus epidermidis through bacterial reduction assays.
  • Analysis of drug elution kinetics and characterization of drug domain morphology using fractal dimension.
  • Comparison of dual-drug loaded UHMWPE with single-drug loaded counterparts.

Main Results:

  • Dual-drug loaded UHMWPE demonstrated a significant additional 1-2 log reduction in bacterial counts compared to single-drug loaded UHMWPE.
  • Increased elution of tolfenamic acid from dual-drug loaded UHMWPE was observed, correlating with enhanced antibacterial efficacy.
  • A higher fractal dimension of drug domains in UHMWPE was associated with increased drug elution and improved antibacterial activity.

Conclusions:

  • Dual-analgesic loaded UHMWPE exhibits superior antibacterial properties against key pathogens responsible for PJIs.
  • This innovative biomaterial holds potential as a component of multi-modal prophylaxis to reduce PJI incidence.
  • The findings suggest a promising strategy to decrease post-arthroplasty morbidity and mortality.
Keywords:
antibacterial prophylaxisantibacterial synergybupivacaineperiprosthetic joint infectionstolfenamic acid

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