Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model
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BIOCOMPATIBILITY STUDIES Original Research
Comparative osteoconductivity of bone void fillers with antibiotics in a critical size bone defect model Rema A. Oliver
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Vedran Lovric1 Chris Christou1 William R. Walsh1 ●
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Received: 15 October 2019 / Accepted: 24 July 2020 © The Author(s) 2020
Abstract The study aimed to evaluate the comparative osteoconductivity of three commercially available bone void fillers containing gentamicin with respect to new bone, growth, host tissue response and resorption of the implant material. Defects were created in the cancellous bone of the distal femur and proximal tibia of 12-skeletally mature sheep and filled with three commercially available bone void fillers containing gentamicin (Stimulan-G, Cerament-G, Herafill-G). Peripheral blood was taken pre-operatively and at the time of implantation, as well as at intermittent timepoints following surgery to determine systemic gentamicin levels (5-,15- and 30- minutes, 1, 2, 3, 6, 12, 24, 48- and 72-hours, 3-, 6- and 12-weeks). Decalcified, embedded samples were stained with haematoxylin and eosin (H&E) and used to assess the host tissue response and the formation of new bone in the presence of test implant materials. No adverse reactions were noted at harvest at any time points for any cancellous implantation sites with the various implant materials. Comparative microCT analysis of the Stimulan-G, Cerament-G and Herafill-G test materials revealed a similar increase in bone surface area and volume between animals implanted with Stimulan-G or Cerament-G test materials. Animals implanted with Herafill-G test materials demonstrated the lowest increases in bone volume and surface area of the test materials tested, at levels similar to the negative control sites. By 12-weeks, Stimulan-G defects were completely closed with mature bone and bone marrow whilst the Cerament-G material was still present after 12 weeks by histological examination. In conclusion, this study demonstrated differences in the bone regenerative capacity of a range of bone void fillers in an in vivo setting. Graphical Abstract
1 Introduction It is important to consider how to manage dead space following the management of infection in cases of periprosthetic
* Rema A. Oliver [email protected] 1
Surgical and Orthopaedic Research Laboratories, UNSW Sydney, Prince of Wales Clinical School, Prince of Wales Hospital, Level 1 Clinical Sciences Building, Randwick, NSW, Australia
joint infection or osteomyelitis. Following infection eradication, osseous repair of the cavity is critical following debridement. Patients with residual dead space are at high risk for subsequent infection or reinfection [1] therefore in the setting of active infection, methods which support the local release of antibiotics are preferable. Poly-methyl methacrylate (PMMA) is a cement that has been successfully used as a void filler in combination with antibiotics for over 40 years [2]. PMMA mixed with antibiotic powder serves as a local antibiotic delivery vehicle
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