Abstract
The purpose of this special issue of Journal of Bone and Joint Infection is to provide orthopaedic surgeons with basic science explanations as to how these local antimicrobials work, clinical evidence that supports these local treatments, and the role of these local treatments against biofilm.
Keywords: local antimicrobial, orthopaedic surgery
Infections after orthopaedic surgery are devastating complications. Now that it has been realized that these chronic infections are caused by biofilm-forming bacterial pathogens, new technologies are required. There have been great strides taken in recent history to prevent and treat infections. Topical antimicrobials are effective methods for preventing infection when used in certain surgical procedures, and are efficacious for treating infectious processes locally. One of the topical antimicrobials covered in this special issue is dilute povidone-iodine, which has been shown to reduce the risk of deep surgical site infection in multiple surgical specialties. Hydrogen peroxide can also be utilized to decrease the risk of reinfection when treating a periprosthetic joint infection, but may be cytotoxic and should not be used in the treatment of partial knee replacements, hemiarthroplasties, or native joints. Chlorhexidine gluconate solution and scrub are useful for a variety of purposes, including pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. Local vancomycin powder has been applied to orthopaedic surgical sites to decrease the risk of infection, and hyaluronic acid can be applied in orthopaedic surgery cases to reduce bacterial adhesion and biofilm formation.
Antibiotics are successfully administrated prophylactically, but systemic application may provide only eradication of planktonic bacteria. Biofilm embedded bacteria usually require much higher concentrations for elimination, which can only be reached by local application, delivering very high concentrations of antibiotics locally and "on demand." Several substances have been identified as possible carriers of antibiotics, such as hydrogels, ceramic biocomposites, impregnated in bone allograft, and loaded into polymethylmethacrylate cement. Antibiotics impregnated in bone allograft has the benefit of restoring bone loss and incorporation into host bone. Ceramic biocomposites can fill bone voids, and polymethylmethacrylate cement can provide strength to areas that are missing bone.
The purpose of this special issue of Journal of Bone and Joint Infection is to provide orthopaedic surgeons with basic science explanations as to how these local antimicrobials work, clinical evidence that supports these local treatments, and the role of these local treatments against biofilm. In addition, this issue details specific algorithms and surgical techniques that readers can emulate when treating chronic musculoskeletal infections in their own institutions. Our hope is that these techniques can be adopted into regular clinical practice for preventing and treating infections after orthopaedic surgery, and may improve the care that we presently provide for our patients.
References
- 1.Lu M, Hansen EN. Hydrogen Peroxide Wound Irrigation in Orthopaedic Surgery. J Bone Joint Infect. 2017;2(1):3–9. doi: 10.7150/jbji.16690. doi:10.7150/jbji.16690. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ruder JA, Springer BD. Treatment of Periprosthetic Joint Infection Using Antimicrobials: Dilute Povidone-Iodine Lavage. J Bone Joint Infect. 2017;2(1):10–14. doi: 10.7150/jbji.16448. doi:10.7150/jbji.16448. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.George J, Klika AK, Higuera CA. Use of Chlorhexidine Preparations in Total Joint Arthroplasty. J Bone Joint Infect. 2017;2(1):15–22. doi: 10.7150/jbji.16934. doi:10.7150/jbji.16934. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Fleischman AN, Austin MS. Local Intra-wound Administration of Powdered Antibiotics in Orthopaedic Surgery. J Bone Joint Infect. 2017;2(1):23–28. doi: 10.7150/jbji.16649. doi:10.7150/jbji.16649. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Anagnostakos K. Therapeutic Use of Antibiotic-loaded Bone Cement in the Treatment of Hip and Knee Joint Infections. J Bone Joint Infect. 2017;2(1):29–37. doi: 10.7150/jbji.16067. doi:10.7150/jbji.16067. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ferguson J, Diefenbeck M, McNally M. Ceramic Biocomposites as Biodegradable Antibiotic Carriers in the Treatment of Bone Infections. J Bone Joint Infect. 2017;2(1):38–51. doi: 10.7150/jbji.17234. doi:10.7150/jbji.17234. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Winkler H, Haiden P. Allograft Bone as Antibiotic Carrier. J Bone Joint Infect. 2017;2(1):52–62. doi: 10.7150/jbji.17466. doi:10.7150/jbji.17466. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Romanò CL, De Vecchi E, Bortolin M, Morelli I, Drago L. Hyaluronic Acid and Its Composites as a Local Antimicrobial/Antiadhesive Barrier. J Bone Joint Infect. 2017;2(1):63–72. doi: 10.7150/jbji.17705. doi:10.7150/jbji.17705. [DOI] [PMC free article] [PubMed] [Google Scholar]