The Effectivity of Porous Hydroxyapatite loaded with Gentamycin on Chronic Tibial Osteomyelitis in Rabbit Models

Ismail Dilogo

Abstract

Introduction. Osteomyelitis management with debridement, guttering, and systemic antibiotics often do not give satisfactory results due to the inability of antibiotics to reach the infection site. Another method of antibiotic delivery in the form of beads are deemed ineffective as it requires two separate surgeries. Combination of local antibiotics with absorbable porous hydroxyappetite scaffolding  and antibiotic carriers have not been studied.

Methods. We conducted pre-test and post-test control group in a rabbit model of osteomyelitis. Ten rabbits divided in control group and the treatment group (n=5). We injected Staphylococcus aureus in the rabbit tibia, forming the osteomyelitis model, and subsequently performed treatment for osteomyelitis. In the control group, we performed debridement and administered ceftriaxone injection for 4 weeks, whereas in the treatment group, we added the combination of porous hydroxyapatite and gentamicin. Afterwards, we performed clinical assessment, x-ray examination, culture, and histopathology.

Results. Radiologically, tibia cortical thickening scores improved in the treatment group compared to the control group (p=0.48) as well as histopathological osteomyelitis evaluation score (p=0,009). Clinically, there were improvements in the swelling scores (n=5) of the treatment group compared to control group, but no significant statistically (p=0.053). In culture, there were no significant difference between the two groups (p=1.00).

Conclusion. Combination of porous hydroxyapatite and gentamicin as a local treatment of osteomyelitis of the rabbit tibia osteomyelitis models improved radiological and histopathological scores and also clinically compared to existing standard treatment procedures for chronic osteomyelitis

Full Text:

PDF

References

De Boeck H. Osteomyelitis and septic arthritis in children. Acta Orthop Belg 2005; 71: 505–515.

Gomes D, Pereira M, Bettencourt AF. Osteomyelitis: An overview of antimicrobial therapy. Brazilian J Pharm Sci 2013; 49: 13–27.

King RW, Johnson D, Stearns DA, Talavera F, Weiss EL, Halamka JD et al. Osteomyelitis in Emergency Medicine. Medscape 2014.

Nade S. Acute Haematogenous Osteomyelitis in infancy and children. J Bone Joint Surg Am 1983; 65.

Calhoun JH, T MJ. Treatment of Osteromyelitis With Biodegradable Antibiotic Implant. Clin Orthop Relat Res 1997; : 206–214.

Klabklay P. The Efficacy and Biocompatibility of Hydroxyapatite Composites Impregnated with Vancomycin as a Local Drug Delivery System. Thai J Orthop Surg 2013; 36: 1–8.

Haidar R, Boghossian A Der, Atiyeh B. Duration of post-surgical antibiotics in chronic osteomyelitis: Empiric or evidence-based? Int J Infect Dis 2010; 14: e752–e758.

Venkatasubbu D, Ramasamy S, Ramakrishnan V, Janakiraman K. Hydroxyapatite-Alginate Nanocomposite as Drug Delivery Matrix for Sustained Release of Ciprofloxacin. J Biomed Nanotechnol 2011; 7: 759–767.

Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg 2009; 23: 80–89.

Tiemann A, Hofmann GO, Krukemeyer MG, Krenn V, Langwald S. Histopathological Osteomyelitis Evaluation Score ( HOES ) – an innovative approach to histopathological diagnostics and scoring of osteomyelitis. Plast Reconstr Surg 2014; 3: 1–12.

Whang PG, Wang JC. Bone graft substitutes for spinal fusion. 2003; 3: 155–165.

Hodges SD, Humphreys SC, Eck JC, Covington L a, Kurzynske NG. Low postoperative infection rates with instrumented lumbar fusion. South Med J 1998; 91: 1132–1136.

Itokazu M, Ohno T, Tanemori T, Wada E, Kato N, Watanabe K. Antibiotic-loaded hydroxyapatite blocks in the treatment of experimental osteomyelitis in rats. J Med Microbiol 1997; 46: 779–783.

Teller M, Gopp U, Neumann HG, Kuhn KD. Release of Gentamicin From Bone Regenerative Materials: An In Vitro Study. J Biomed Mater Res 2007; : 23–29.

Itokazu M, Matsunaga T, Kumazawa S, Wenyi Y. A novel drug delivery system for osteomyelitis using porous hydroxyapatite blocks loaded by centrifugation. J Appl Biomater 1995; 6: 167–169.

Shinto Y, Uchida A, Korkusuz F, Araki N, Ono K. Calcium Hydroxyapatite Ceramic Used As System for Ceramic Antibiotics. J Bone Jt Surg [Br] 1992; 74: 600–604.

Yamashita Y, Uchida a., Yamakawa T, Shinto Y, Araki N, Kato K. Treatment of chronic osteomyelitis using calcium hydroxyapatite ceramic implants impregnated with antibiotic. Int Orthop 1998; 22: 247–251.

Krisanapiboon a, Buranapanitkit B, Oungbho K. Biocompatability of hydroxyapatite composite as a local drug delivery system. J Orthop Surg (Hong Kong) 2006; 14: 315–318.

Mustaffa R, Yusof MR, Othman F, Rahmat A. Drug release study of porous hydroxyapatite coated gentamicin as drug delivery system. Regen Res 2012; 1: 61–67.

Sánchez E, Baro M, Soriano I, Perera A, Évora C. In vivo-in vitro study of biodegradable and osteointegrable gentamicin bone implants. Eur J Pharm Biopharm 2001; 52: 151–158.

Cheung a. L, Fischetti V a. Variation in the expression of cell wall proteins of Staphylococcus aureus grown on solid and liquid media. Infect Immun 1988; 56: 1061–1065.

Schulz S, Steinhart H, Mutters R. Model. J Investig Surg 2001; 14: 121–131.

Concia E, Prandini N, Massari L, Ghisellini F, Consoli V, Menichetti F et al. Osteomyelitis: clinical update for practical guidelines. Nucl Med Commun 2006; 27: 645–6.

Mikus JR, Worsham J, Aung H, Clifton D, Walser EM. The role of bone biopsy in osteomyelitis—utility or futility? J Vasc Interv Radiol 2015; 24: S31–S32.

Lazzarini L, Lipsky B a., Mader JT. Antibiotic treatment of osteomyelitis: What have we learned from 30 years of clinical trials? Int J Infect Dis 2005; 9: 127–138.

Lee JH, Hwang C-J, Song B-W, Koo K-H, Chang B-S, Lee C-K. A prospective consecutive study of instrumented posterolateral lumbar fusion using synthetic hydroxyapatite (Bongros-HA) as a bone graft extender. J Biomed Mater Res A 2009; 90: 804–810.

Atkins BL, Athanasou N, Deeks JJ, Crook DWM, Simpson H, Peto TE a et al. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. J Clin Microbiol 1998; 36: 2932–2939.

Cierny G. Chronic osteomyelitis: Results of treatment. In: Greene WB (ed). Instructional Course Lectures. American Academy of Orthopedic Surgeons: Rosemont, 1990, pp 495–505

.

Gross T, Kaim AH, Regazzoni P, Widmer AF. Current concepts in posttraumatic osteomyelitis: a diagnostic challenge with new imaging options. J Trauma 2002; 52: 1210–1219.

Refbacks

  • There are currently no refbacks.


Bookmark and Share