Early Experience With Defensive Antibacterial Coating (DAC®) Hydrogel in High-Risk Orthopaedic Implant Surgery

Periprosthetic joint infections (PJIs) after hip and knee arthroplasty and osteosynthesis-associated infections (OAIs) after fracture fixation remain major clinical and economic burdens. High-risk patients with advanced age, multiple comorbidities, and socioeconomic deprivation are particularly vulnerable. Defensive Antibacterial Coating (DAC®) hydrogel (Novagenit S.r.l., Mezzolombardo, Italy) is a fully resorbable hyaluronic acid/poly-D,L-lactide coating that reduces early bacterial adhesion and can act as a carrier for local antibiotic delivery.

A retrospective cohort study was conducted including patients who underwent orthopaedic arthroplasty or osteosynthesis procedures with intraoperative DAC® application between April 2022 and October 2023. Patients were selected based on clinical factors associated with an increased risk of postoperative infection, including advanced age, multiple comorbidities, the nature of the planned orthopaedic procedure, and consultant surgeon judgement. Demographic, biochemical, and deprivation (Welsh Index of Multiple Deprivation (WIMD)) data were collected. Operative time and perioperative variables were recorded where available. Patients were reviewed clinically and radiographically at six weeks and six months.  Results: Twenty-one patients received DAC®. The mean age was 72.5±15.04 years, American Society of Anesthesiologists (ASA) 2.57±0.74, Charlson Comorbidity Index 5.76±2.34, and deprivation score 6.89±2.37. Procedures included the hip/femur (n=9), knee (n=2), foot and ankle (n=6), and shoulder (n=4). Procedures were further analysed in two groups: arthroplasty (n=6) and osteosynthesis (n=15). The mean operative time was 146.80±32.91 minutes (range: 81-193 minutes). No postoperative implant-related infections were identified during the six-week and six-month follow-up period.  Conclusion: In this real-world high-risk cohort, no postoperative implant-related infections were identified following intraoperative DAC® hydrogel use. Larger controlled studies are required to confirm efficacy and cost-effectiveness.