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Orthopaedic infections: novel treatment strategies and evolving concepts
Christopher Lee1, I Leah Gitajn2, Kyle Schweser3
1Department of Orthopaedic Surgery, University of California Los Angeles, Los Angeles, CA.
Abstract:
Orthopaedic infections remain challenging complications to treat, with profound economic impact in addition to patient morbidity. The overall rate of infection following orthopaedic surgery with internal fixation devices has been estimated at 5%, with hospital costs 8 times that of those without fracture-related infections and with significantly poorer outcomes regarding function and pain. Fracture-related infections (FRIs) occur in approximately 20% of all trauma cases, and treatment has evolved very little over the years. While union can be achieved 70%-89% of the time, long-term recurrence rates vary between 9% and 58% and retention of implants is only around 30%-40%. This is underscored by the financial, psychosocial, and physical burden placed on the patients. The difficult management of FRIs is multifactorial; however, a major contributor is biofilm. Alternative treatment strategies to combat biofilm have come in the form of photodynamic therapy and bacteriophage therapy. Use of local antibiotic therapy in the form of powder and dissolvable antibiotic beads has continued to be expanded, with new applications explored. Systemic antibiotic use has continued to be optimized, with new treatment protocols calling for per os (PO) administration as opposed to intravenous. In conclusion, orthopaedic infections remain difficult clinical dilemmas, although evolving prevention and treatment modalities continue to emerge.
Insights
Orthopaedic infections pose significant challenges, leading to high costs and poor patient outcomes. Emerging treatments like bacteriophage therapy and optimized antibiotic protocols offer new hope for managing these difficult-to-treat conditions.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Biomaterials
Background:
- Orthopaedic infections are costly complications impacting patient morbidity and function.
- Fracture-related infections (FRIs) affect approximately 20% of trauma cases, with limited treatment evolution.
- Biofilm formation is a major factor contributing to the difficulty in managing FRIs.
Purpose of the Study:
- To review the challenges and evolving treatment strategies for orthopaedic infections.
- To highlight the economic and patient burden associated with fracture-related infections.
- To explore novel therapeutic approaches beyond traditional antibiotic regimens.
Main Methods:
- Literature review of current orthopaedic infection management.
- Analysis of treatment outcomes, including union rates, recurrence, and implant retention.
- Exploration of alternative therapies such as photodynamic and bacteriophage therapy.
- Evaluation of advancements in local and systemic antibiotic administration.
Main Results:
- High recurrence rates (9-58%) and low implant retention (30-40%) persist in current FRIs treatment.
- Hospital costs for infected patients are 8 times higher than for uninfected patients.
- Emerging therapies show promise in combating biofilm and improving treatment efficacy.
Conclusions:
- Orthopaedic infections remain complex clinical problems with substantial patient and economic impact.
- Advancements in local and systemic antibiotic delivery, alongside novel therapies, are crucial for improved outcomes.
- Continued research into biofilm-disrupting strategies and optimized treatment protocols is essential.
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