Prophylaxis of infection and effects on osseointegration using a tobramycin-periapatite coating on titanium implants—An experimental study in the rabbit

✍ Scribed by 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

• Publisher: Elsevier Science
• Year: 2009
• Tongue: English
• Weight: 299 KB
• Volume: 27
• Category: Article
• ISSN: 0736-0266
• DOI: 10.1002/jor.20808

✦ Synopsis

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), 10^3^, 10^4^ or 10^5^ 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