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Review
. 2018 Apr 30;20(6):33.
doi: 10.1007/s11926-018-0742-4.

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

Ashley E Levack  1 , Erika L Cyphert  2 , Mathias P Bostrom  1 , Christopher J Hernandez  1   3   4 , Horst A von Recum  5 , Alberto V Carli  1   6
Affiliations
Review

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

Ashley E Levack et al. Curr Rheumatol Rep. .

Abstract

Purpose of review: Infection in the setting of total joint arthroplasty, referred to as periprosthetic joint infection (PJI), is a devastating complication requiring prolonged and costly treatment. The unique environment around an artificial joint and ability of surrounding tissues to sequester bacteria collectively make prevention, diagnosis, and treatment of this condition challenging. In light of the unique pathogenesis of PJI, this review explores the limitations of contemporary treatments and discusses novel treatment options.

Recent findings: Recent advancements in local antibiotic delivery platforms for preventing and treating PJI include titanium nanotube arrays, synthetic polymers, resorbable hydrogels, and cyclodextrin-based drug delivery options. In particular, cyclodextrins have facilitated great advancements in other clinical disorders and have demonstrated early promise as a future option in the arena of PJI. Novel treatment modalities for PJI optimize the implant surfaces to prevent bacterial biofilm formation or provide prolonged intra-articular antibiotic dosing to eradicate bacteria.

Keywords: Calcium sulfate; Controlled antibiotic release; Cyclodextrin; PMMA; Periprosthetic joint infection; Polymethylmethacrylate.

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Conflict of interest statement

Conflict of Interest Dr. Bostrom reports a grant from the National Institutes of Health, during the conduct of the study. Dr. Bostrom reports other (Consultant for Smith & Newphew) for relevant financial activities outside the submitted work.

Dr. von Recum reports co-ownership Affinity Therapeutics LLC., outside the submitted work.

Dr. Levack, Dr. Carli, Dr. Hernandez, and Erika Cyphert declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
(a) Daily release profile from cyclodextrin (CD) (affinity-based) polymers as compared to drug release through diffusion (example: PMMA). Diffusion-based release results in a large bolus of drug release in the first few days (potentially cytotoxic) and sub-inhibitory release at later times. In contrast, release from cyclodextrin polymers is affinity-based, extending release within the desired treatment window for longer periods of time and avoiding an initial bolus effect. (b) Polymers that use affinity-based release may be refilled after implantation, further extending the presence of the pharmaceutical within the treatment window. In vitro and in vivo animal studies have demonstrated efficacy of this technique [88,99••]
See this image and copyright information in PMC

References

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