Medical practitioners often face particular challenges when treating infections in orthopaedics and traumatology. Particular attention must be paid to high-risk patients which include obese or immunocompromised patients or those with diabetes or cardiovascular diseases as well as smokers, severely injured patients and patients with multiple previous surgeries.
Heraeus Medical, market leader for bone cements and biomaterials for orthopaedic and trauma surgery, has been involved for years developing new solutions for infection management in orthopedics and traumatology. Especially the worldwide increase of antibiotic resistance as well as the changing bacterial spectrum of patients require continuous development of solutions to combat infections in joint replacements. This year, therefore, the company held a symposium on infection in high-risk patients at the German Congress of Orthopaedics and Traumatology (DKOU, Berlin, 20.-23.10.2015). Here two leading specialists discussed the latest findings and procedures for the prevention and treatment of infections in this particular group of patients. As experts spoke Prof. Dr. med. Wolfram Mittelmeier and Prof. Dr. med. Volker Bühren.
Patient-adapted treatment with antibiotics necessary
Both experts agreed that for high-risk patients, combined local and systemic use of antibiotics is indispensable. However, both for joint replacement surgery and in traumatology, the administration of these medications must be adapted to the particular patient as well as the bacteria present and any antibiotic resistance.
‘On one hand, long-term systemic treatment with antibiotics often leads to more complications than positive effects. On the other hand, the antibiotics must specifically reach affected tissue. For high-risk patients with scarring of the local tissue, poor blood flow or poor wound healing, systemically administered antibiotics usually do not reach the target area at all. A combination of systemic and local antibiotics is therefore the ideal solution,’ explained Professor Wolfram Mittelmeier from the Orthopaedic Clinic and Polyclinic of the University of Rostock.
‘The quality of the debridement, that is, the cleaning of the wound, is critically important for the outcome of joint replacement or revision surgery. The same is true in traumatology’, added Professor Volker Bühren, Professor for Surgery, Medical Director and Clinic Managing Director of the Murnau Trauma Centre as well as Senior Consultant in the Department of Trauma Surgery at the Garmisch-Partenkirchen Hospital. ‘Locally administered antibiotics can be used to prevent infections. However, foreign bodies such as antibiotic-impregnated PMMA beads or collagen fleece themselves act in the medium term as a culture medium for pathogens that preferentially colonize implants and surfaces. What is needed here is to improve existing systems but also to develop new carrier materials, such as ones with absorbable properties.’
Regarding infection prophylaxis, e.g. to prevent biofilm formation on an artificial joint or as an adjunct to therapy as part of infection eradication, the use of antibiotic-loaded bone cement from Heraeus Medical is an option but it must satisfy the most stringent requirements: It must not create any particle deposits in the wound and it should contain and deliver an adequately high dose of antibiotics. It must also be noted that many bacteria no longer respond adequately to the antibiotic commonly used on bone cement, gentamicin.
The solution lies in new approaches such as COPAL® bone cement developed by Heraeus Medical for revision arthroplasty. COPAL® bone cement contains optimally tailored combinations of antibiotics for anchoring implants or for use as a temporary place holder (spacer) and is primarily used in two-stage revision surgery. Heraeus Medical provides a special spacer cement characterized by reduced particle wear to prepare articulating spacers.
Heraeus Medical: A stronger focus on new solutions in orthopaedics and traumatology
Heraeus Medical will continue to strengthen its involvement in the area of new anti-infectious solutions in orthopaedics and traumatology in the coming years. Dr André Kobelt, Managing Director of Heraeus Medical GmbH explains: ‘The demands of orthopaedics and trauma surgery are becoming more and more exacting. Not only the worldwide increase in antibiotic resistance but also the individual and fluctuating microbial spectrum of the patient means that it is essential to constantly refine solutions to tackle infections in joint replacement and traumatology. Approaches that intrinsically prevent an infection are of great importance for high-risk patients. It is a major goal of Heraeus Medical to drive the developments being made in this area of medicine.’