Pressato Daniele, Battista Angela, Govoni Marco, Vivarelli Leonardo, Dallari Dante, Pellegrini Antonio
Clinical and Scientific Affairs, Novagenit S.r.l., 38017 Mezzolombardo, Italy.
Quality Assurance and Regulatory Affairs, Novagenit S.r.l., 38017 Mezzolombardo, Italy.
Materials (Basel). 2023 Jul 28;16(15):5304. doi: 10.3390/ma16155304.
Periprosthetic joint infections (PJIs) in arthroplasty and osteosynthesis-associated infections (OAIs) in reconstructive surgery still represent a challenging complication in orthopaedics and traumatology causing a burden worsening the patient's quality of life, for caregiver and treating physicians, and for healthcare systems. PJIs and OAIs are the result of bacterial adhesion over an implant surface with subsequent biofilm formation. Therefore, the clinical pathological outcome is a difficult-to-eradicate persistent infection. Strategies to treat PJIs and OAIs involve debridement, the replacement of internal fixators or articular prostheses, and intravenous antibiotics. However, long treatments and surgical revision cause discomfort for patients; hence, the prevention of PJIs and OAIs represents a higher priority than treatment. Local antibiotic treatments through coating-release systems are becoming a smart approach to prevent this complication. Hydrophilic coatings, loaded with antibiotics, simultaneously provide a barrier effect against bacterial adhesion and allow for the local delivery of an antibiotic. The intraoperative use of a hyaluronan (HY)-derivative coating in the form of a gel, loaded with antibiotics to prevent PJI, has recently raised interest in orthopaedics. Current evidence supports the use of this coating in the prophylaxis of PJI and IRIs in terms of clinical outcomes and infection reduction. Thus, the purpose of this narrative review is to assess the use of a commercially available HY derivative in the form of a gel, highlighting the characteristics of this biomaterial, which makes it attractive for the management of PJIs and IRIs in orthopaedics and traumatology.
关节置换术中的假体周围关节感染（PJI）和重建手术中与骨固定相关的感染（OAI）仍然是骨科和创伤学中具有挑战性的并发症，给患者、护理人员和治疗医生以及医疗系统带来负担，降低患者生活质量。PJI和OAI是细菌粘附在植入物表面并随后形成生物膜的结果。因此，临床病理结果是一种难以根除的持续性感染。治疗PJI和OAI的策略包括清创、更换内固定器或关节假体以及静脉注射抗生素。然而，长期治疗和手术翻修会给患者带来不适；因此，预防PJI和OAI比治疗更为重要。通过涂层释放系统进行局部抗生素治疗正成为预防这种并发症的明智方法。负载抗生素的亲水涂层同时提供抗细菌粘附的屏障作用，并允许局部递送抗生素。术中使用负载抗生素的透明质酸（HY）衍生物凝胶涂层来预防PJI，最近在骨科领域引起了关注。目前的证据支持在预防PJI和感染性翻修方面使用这种涂层，在临床结果和减少感染方面均有效果。因此，本叙述性综述的目的是评估市售凝胶形式的HY衍生物的使用情况，突出这种生物材料的特性，这使其在骨科和创伤学中对PJI和感染性翻修的管理具有吸引力。
