Local Antibacterial Implant Protection in Orthopedics and Trauma: What’s New?

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Abstract

Current prophylactic and hygienic measures notwithstanding, implant-related infection remains among leading reasons for failure in orthopaedics and trauma surgery, resulting in extremely high social and economic costs. Various antibacterial coating technologies have been proven safe and effective both in preclinical and in clinical settings and able to reduce post-surgical infections up to 90%, depending on the type of the coating and on the experimental setup. In spite of this findings, the widespread use of these technologies is still limited by several factors. After reviewing the latest evidence on currently available antibacterial coatings, an algorithm is proposed to calculate the impact of the delayed introduction of these technologies in the clinical practice. When applied to joint arthroplasties, our calculator shows that each year of delay to implement an antibacterial coating, able to reduce post-surgical infection by 80% at a final user’s cost price of €600, causes an estimated 35 200 new cases of periprosthetic joint infection in Europe and additional annual hospital costs of approximately €440 million. Faster and more affordable regulatory pathways for antibacterial coating technologies and an adequate reimbursement policy for their clinical use appear a feasible solution to mitigate the impact of implant-related infections and may benefit patients, healthcare systems, and related research.

All patients provided written informed consent.

Competing interests: the authors declare that there are no competing interests.

About the authors

C. L. Romanò

Studio Medico Associato Cecca-Romanò,
Romano Institute

Author for correspondence.
Email: carlo.romano@unimi.it

Carlo Luca Romanò — MD, Orthopaedic Consultant

Milan

Director 

Tirane, Albania

Italy

S. A. Bozhkova

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Svelana Bozhkova — Dr. Sci. (Med.), Head of the Research Department of Prevention and Treatment of Wound Infection and Department of Clinical Pharmacology

St. Petersburg

Russian Federation

V. Artyukh

Vreden Russian Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Vasilii Artyukh — Cand. Sci. (Med.), Head of Department

St. Petersburg

Russian Federation

D. Romanò

Studio Medico Associato Cecca-Romanò

Email: fake@neicon.ru

Delia Romanò — MD, Consultant

Milan

Italy

H. Tsuchiya

Graduate School of Medical Sciences, Kanazawa University

Email: fake@neicon.ru

Hiroyuki Tsuchiya — MD, PhD, Professor and Chairman, Department of Orthopaedic Surgery

Kanazawa

Japan

L. Drago

University of Milan

Email: fake@neicon.ru

Lorenzo Drago — PhD, Professor, Clinical Microbiology Department of Biomedical Sciences for Health

Milan

Italy

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