A biodegradable gentamicin-hydroxyapatite-coating for infection prophylaxis in cementless hip prostheses
1 University of Groningen and University Medical Center Groningen, Department of Biomedical Engineering and
2 Department of Orthopaedic Surgery, Antonius Deusinglaan 1, 9713 A V Groningen, The Netherlands.
3 DePuy Synthes Joint Reconstruction, Number One, White Rose Office Park, Millshaw Park Lane, Leeds LS11 0BG, UK.
4 DePuy Ireland, Loughbeg, Ringaskiddy, Cork, Ireland.
Abstract
A degradable, poly (lactic-co-glycolic acid) (PLGA), gentamicin-loaded prophylactic coating for hydroxyapatite (HA)-coated cementless hip prostheses is developed with similar antibacterial efficacy as offered by gentamicin-loaded cements for fixing traditional, cemented prostheses in bone. We describe the development pathway, fromin vitroinvestigation of antibiotic release and antibacterial properties of this PLGA-gentamicin-HA-coating in differentin vitromodels to an evaluation of its efficacy in preventing implant-related infection in rabbits. Bone in-growth in the absence and presence of the coating was investigated in a canine model. The PLGA-gentamicin-HA-coating showed high-burst release, with antibacterial efficacy in agar-assays completely disappearing after 4 days, minimising risk of inducing antibiotic resistance. Gentamicin-sensitive and gentamicin-resistant staphylococci were killed by the antibiotic-loaded coating, in a simulated prosthesis-related interfacial gap. PLGA-gentamicin-HA-coatings prevented growth of bioluminescent staphylococci around a miniature-stem mounted in bacterially contaminated agar, as observed using bio-optical imaging. PLGA-gentamicin-HA-coated pins inserted in bacterially contaminated medullary canals in rabbits caused a statistically significant reduction in infection rates compared to HA-coated pins without gentamicin. Bone ingrowth to PLGA-gentamicin-HA-coated pins, in condylar defects of Beagle dogs was not impaired by the presence of the degradable, gentamicin-loaded coating. In conclusion, the PLGA-gentamicin-HA-coating constitutes an effective strategy for infection prophylaxis in cementless prostheses.
Keywords
- Cementless prosthesis
- gentamicin-releasing coating
- hydroxyapatite
- antibiotic release
- antibacterial efficacy
- bone ingrowth
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