Prophylaxis of infection and effects on osseointegration using a tobramycin-periapatite coating on titanium implants—An experimental study in the rabbit |
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Authors: | Dirk Jan F. Moojen H. Charles Vogely André Fleer Peter G.J. Nikkels Paul A. Higham Abraham J. Verbout René M. Castelein Wouter J.A. Dhert |
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Affiliation: | 1. Department of Orthopaedics, University Medical Center Utrecht, Room G05.228, P.O. Box 85500, Heidelberglaan 100, 3484CX Utrecht, The Netherlands;2. Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands;3. Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands;4. Stryker Orthopaedics, 325 Corporate Drive, Mahwah, New Jersey 07430 |
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Abstract: | No options are available for local antibiotic delivery from uncemented implants. By loading a porous titanium implant with a biomimetic HA-coating (PeriApatite, PA) with antibiotics, we could obtain adequate local antibiotic concentrations and reduce infection susceptibility. This study investigated the efficacy of a tobramycin-loaded PA-coated titanium foam implant in preventing infection, as well as the effects on osseointegration. In 72 New Zealand White rabbits, an uncoated (Ti), PA-coated (PA), or Tobramycin-PA-coated (PA-tobra) titanium foam rod was implanted intramedullary in the left tibiae after contamination of the implant bed with none (control), 103, 104 or 105 CFU Staphylococcus aureus. PA-tobra implants were loaded with 2.4 mg tobramycin. After 28 days analysis was done by bacteriology, histopathology and histomorphometry. Six percent of the contaminated PA-tobra rabbits were infected, whereas this was 53 and 67% for PA and Ti, respectively (p < 0.001). Quantitative cultures were also significantly lower in the PA-tobra group (p = 0.003). None of the control rabbits were infected. Histopathological and histomorphometrical scores were both better for the PA-tobra group, although only significant compared to Ti. No significant differences were observed between PA and Ti rabbits. We conclude that the application of tobramycin to PA-coated titanium foam implants appears to be an effective local antibiotic strategy for uncemented implants for infection prophylaxis and has a beneficial effect on implant fixation, which will result in improved long-term implant survival. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 710–716, 2009 |
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Keywords: | osseointegration prophylaxis of infection tobramycin-periapatite coating titanium implants |
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