Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts.
Department of Orthopaedic Surgery, Harvard Medical School, Harvard University, Boston, Massachusetts.
J Orthop Res. 2019 Apr;37(4):981-990. doi: 10.1002/jor.24243. Epub 2019 Mar 20.
Despite being a relatively safe surgery, total joint replacement is often associated with two major complications-severe post-operative pain and periprosthetic joint infection. Local sustained delivery of therapeutics to the surgical site has a potential to address these complications more effectively than current clinical approaches. Given that several analgesics were shown to possess antibacterial activity, we propose here to use analgesic-loaded ultra-high molecular weight polyethylene (UHMWPE) as a delivery vehicle to provide antimicrobial effect after an arthroplasty. Three commonly used anesthetics, lidocaine, bupivacaine, and ropivacaine, were analyzed in order to reveal the drug with the highest antibacterial activity against methicillin-sensitive Staphylococcus aureus. Having shown highest antibacterial activity in the bacterial susceptibility tests, bupivacaine was chosen to be incorporated into UHMWPE to provide antibacterial properties. Bupivacaine-loaded UHMWPE possessed moderate dose-dependent antimicrobial properties, decreasing the S. aureus proliferation rate by up to 70%. Biofilm formation was also substanitally inhibited during the first 9 h of culture as quantified by bacterial counts and SEM. This proof-of-concept study is first of its kind to demonstrate that analgesic-loaded UHMWPE can be used as part of a multimodal antimicrobial therapy. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
尽管全关节置换术是一种相对安全的手术，但它通常与两种主要并发症有关——严重的术后疼痛和假体周围关节感染。局部持续向手术部位输送治疗药物，有可能比目前的临床方法更有效地解决这些并发症。鉴于几种镇痛药具有抗菌活性，我们在这里提出使用载药超高分子量聚乙烯（UHMWPE）作为一种给药载体，在关节置换术后提供抗菌作用。为了揭示对甲氧西林敏感的金黄色葡萄球菌具有最高抗菌活性的药物，分析了三种常用的麻醉剂——利多卡因、布比卡因和罗哌卡因。在细菌药敏试验中表现出最高的抗菌活性后，选择布比卡因掺入 UHMWPE 中以提供抗菌性能。布比卡因负载的 UHMWPE 具有适度的剂量依赖性抗菌特性，使金黄色葡萄球菌的增殖率降低了多达 70%。通过细菌计数和 SEM 定量，在培养的前 9 小时内也明显抑制了生物膜的形成。这项概念验证研究首次表明，载药 UHMWPE 可用作多模式抗菌治疗的一部分。©2019 骨科研究协会。由 Wiley 期刊出版公司出版。J 骨科研究。
