The Application of Antibiotic-Loaded Hydrogel Coating in Orthopaedic Oncology: Early Experience of a Single Centre

Introduction: Infection is one of the most severe complications of orthopaedic procedures. Orthopaedic Oncology reconstructive surgery has an higher risk of infection due to duration of procedures, large exposition, blood loss, patient immunodeficiency, radiotherapy and the use of megaprosthesis and bone grafts. According to preclinical studies, Antibacterial coatings may prevent bacterial adhesion and biofilm formation. We presents our early experience in using an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC) in Orthopaedic Oncology.

Methods: DAC was used in 29 patients between 2014 and 2018. Pre and post-operative assessment of scores were measured considering wound healing, laboratory tests, and radiological findings. Results were compared to historical outcomes.

Results: Surgery was mostly performed on the diagnosis of tumor (26) with the exception of 2 cases of aseptic and one of septic loosening. 8 patients had a primary bone malignancy, 9 primary benign lesion and 9 metastatic/systemic disease. Proximal femur was the most frequent site (11). 7 patients received chemiotherapy and 2 radiotherapy before the surgery. Trevira tube was used in 12 cases and massive bone graft in 2 cases. DAC was added with Gentamycin (16) or Vancomycin (13). Tobramycin and Teicoplanin were used in systemic prophylaxis in most of cases (20). At the first end point (30 days) 3 patients experienced difficult wound healing, one deep infection was observed and treated without the removal of the implant. No local or systemic side effects related to the use of DAC were registered and no interference with implant osteointegration or bone and soft tissue healing was observed.

Conclusions: In our experience the use of a fast-resorbable antibiotic-loaded hydrogel implant coating is manageable and safe. This early results support the need of randomized clinical studies to access the efficacy of this device in Orthopaedic Oncology.