This review covers four areas: the use of prophylactic antibiotics in orthopedic surgery not involving prosthetic devices; the use of prophylactic antibiotics in prosthetic joint implantation; the use of antibiotic-containing cement in prosthetic joint surgery; and the use of prophylactic antibiotics for dental procedures in individuals with implanted prosthetic joints. The major conclusions are as follows: (1) Prophylactic antimicrobial agents lower the rate of wound infection following surgery for closed hip fractures. (2) Antimicrobial prophylaxis reduces the frequency of deep wound infection following total joint replacement; operating rooms with ultraclean air have a similar effect. (3) Antibiotic-impregnated cement is as effective as systemic antibiotics in preventing early infection following total joint replacement. (4) For routine dental work in most patients with total joint replacement, there is insufficient evidence to support antibiotic prophylaxis; for such individuals with periodontal disease or potential dental infection, antimicrobial prophylaxis seems indicated.
"Antibiotics are frequently prescribed medicine in orthopaedics unit (Yusof et al., 2004). The antibiotics are prescribed both as prophylactically (before orthopaedics surgery etc.) or to treat current infection (septic arthritis, osteomyelitis etc.) (Norden, 1976). Infection is a very prevailing problem in the orthopaedic surgery because of its continuing incidence, clinical importance and serious sequels, the treatment being very difficult and expensive. "
"Several decades after the discovery of the first antibiotic, bone infections still represent a major problem in medicine. Recent studies estimate the current incidence of infection to be around 2% and 4% in total hip and knee arthroplasties, respectively       . The figures can increase to 50%, due to pin track infections, when external fracture fixators are used in trauma surgery  . "
[Show abstract][Hide abstract] ABSTRACT: Calcium phosphate coatings containing an antibiotic were produced on titanium alloy (Ti6Al4V) implants using a biomimetic approach. Thin, amorphous calcium phosphate (ACP) coatings were first deposited onto Ti6Al4V plates by immersion in 5 times concentrated simulated body fluid (SBF), for 24h at 37 degrees C. The ACP-coated implants were then immersed in a supersaturated calcium phosphate (SCP) solution containing 0, 100, 200, 400, 600 or 800 mg/l of tobramycin for 48 h at 37 degrees C. A carbonated hydroxyapatite (CHA) layer, approximately 40 microm thick, was formed. Approximately 3 microg/mg of tobramycin was co-precipitated with the CHA crystals onto titanium alloy plates, using 800mg/l tobramycin in the coating solution. For comparison, plasma-sprayed calcium phosphate coatings were also immersed in solutions containing 100, 200, 400 or 1,000 mg/l of tobramycin for 10, 40 min, or 48 h. A maximum of about 0.3 microg/mg could be adsorbed onto the plasma-sprayed calcium phosphate coating with the comparable concentration of 800 mg/l in solution. The dissolution of coating and release of tobramycin were also measured in vitro using saline solution buffered at pH 5.0 or 7.3 at 37 degrees C. The release rate of tobramycin was faster at pH 7.3 than at pH 5, with 50 and 4 microg/ml/min, respectively. Tobramycin released from the biomimetic-coated plates could inhibit growth of Staphylococcus aureus bacteria. The result of this study, therefore, indicates that the biomimetic CHA coatings containing antibiotics could be used to prevent post-surgical infections in orthopaedic or trauma.
[Show abstract][Hide abstract] ABSTRACT: Percutaneous vertebroplasty (PV) is a safe and effective treatment for relieving pain in patients complaining of severe back pain induced by osteoporotic or neoplastic compression fractures. The success rate exceeds 90% and the complication rate is lower than 1%. Most of the complications are transient. The classic indication for PV is severe, persistent, and incapacitating focal back pain not responding to standard medical therapy and related to one or more collapsed vertebral bodies of 4 to 12 weeks duration.
JBR-BTR: organe de la Société royale belge de radiologie (SRBR) = orgaan van de Koninklijke Belgische Vereniging voor Radiologie (KBVR) 04/2001; 86(5):299-301. DOI:10.1177/197140090101400222
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