THE MANAGEMENT OF

PERIPROSTHETIC INFECTION
IN THE FUTURE
A REVIEW OF NEW FORMS OF TREATMENT

D. A. George, V. Gant, F. S. Haddad

THE BONE & JOINT JOURNAL, SEPTEMBER 2015

dr. W. Hilmy Sulaiman

dr. Pandu Anugrawan, SpOT
RSUD Provinsi Banten
2015

PROLOGUE
The number of arthroplasties being
undertaken is expected to grow year on
year.
Despite many initiatives to reduce it over
the years, the rate of periprosthetic joint
infection (PJI) remains at 1%-2%.
Most common pathogen: S. Aureus
Adheres to the prosthesis, duplicates,
colonises.
Becomes resistant to antibiotics.

PROLOGUE
Biofilm:
Polypeptides
Polysaccharides
Nucleic acid

PATIENTS AND METHODS

Reviewed all papers with a full text or an
abstract in English which is published
from 1970 to June 2014.
International databased that used for this
journal:
PubMed/Medline
EMBASE
others

PATIENTS AND METHODS

KEYWORDS USED DURING THE INITIAL AND EXPANDED
LITERATURE SEARCH
INITIAL SEARCH

EXPANDED SEARCH

Periprosthetic joint infections

Photodynamic therapy

Implant infections

Metal ions

Prosthesis infections

Nanoparticles

Hip infections

Magnetic fields

Knee infections

Electric fields

Shoulder infections
Future
Patient
Modifications
Theatre
Technique

RESULTS
1.
2.
3.
4.
5.
6.
7.

Theatre modifications
Operative modifications
Modification of prostheses
Antibiotic prosthetic coatings
Antibiofilm prosthetic coatings
Intra-operative applied therapies
External antimicrobial therapy

THEATRE MODIFICATIONS
Presence of five people: increase the
bacterial count by 34 times (from skin,
respiratory particles, hair, clothing)
Laminar flow
UV light
Sterilising the operating room between
patients or overnight

OPERATIVE MODIFICATIONS

Prophylactic systemic antibiotics

Antibiotic impregnated cement
Pulsatile lavage
Antibiotic impregnated plastic adhesive
drapes

MODIFICATIONS OF
PROSTHESES
Structure of the prosthesis
Surface
Texture
Hydrophobicity

Ions that used for modification

Silver
Zink
Iron
Titanium
Carbon

ANTIBIOTICS PROSTHETIC
COATINGS

Vancomycin
Gentamicin
Ceftriaxone
Kanamycin
Tetracycline
Doxycycline
Levofloxacin

ANTIBIOFILM PROSTHETIC COATINGS

Deoxyribonuclease (Dnase) 1
Degrades extracellular DNA, known to
cause firmness and stability of the
biofilm and inhibit biofilm formation,
making it more susceptible to various
antibiotics.

Dispersin B
Targets intercellular adhesion produced
by the biofilm.

INTRA OPERATIVE APPLIED THERAPIES

Cancellous allograft bone
impregnated with antibiotics.
Gentamicin
Calcium sulphate + antibiotics
(vancomycin)

EXTERNAL ANTIMICROBIAL
THERAPY
Photodynamic therapy (PDT)
Magnetic and electric fields
Charge nanotubular titanium using a
voltage of 15 to 30 volts decrease
formation of biofilm

Shockwave treatment

EPILOGUE
Bacteria cannot be fully eradicated
from the skin. S. Aureus is a human
commensal, adding the risk of infection
to every incision, despite skin
antisepsis.
The test demonstrate that bacteria can
adhere to the surface of the prosthesis,
but not sufficient to cause infection.

Q&A
Dr. Asep SpBS tampilkan dulu
abstraknya. Yang dibagikan ke peserta
adalah full text, jangan ppt. jika ada
infeksi, bagaimana tata laksananya?
Jika belum ada implan failure, AB dulu.

dr. bernard Antibiotik coating &

antibiofilm coating sudah ada atau
belum?
Antibiofilm masih wacana.