Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads
<p><strong>Introduction</strong>: Local antimicrobial delivery via calcium sulfate (CaSO<span class="inline-formula"><sub>4</sub></span>) beads is used as an adjunctive treatment for periprosthetic joint infection. There is limited clinical informa...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Copernicus Publications
2022-05-01
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| Series: | Journal of Bone and Joint Infection |
| Online Access: | https://jbji.copernicus.org/articles/7/117/2022/jbji-7-117-2022.pdf |
| _version_ | 1828213981845651456 |
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| author | E. J. McPherson J. A. Jennings O. Yunis M. A. Harris M. V. Dipane N. L. Curtin M. Chowdhry A. J. Wassef J. D. Bumgardner S. P. Noel |
| author_facet | E. J. McPherson J. A. Jennings O. Yunis M. A. Harris M. V. Dipane N. L. Curtin M. Chowdhry A. J. Wassef J. D. Bumgardner S. P. Noel |
| author_sort | E. J. McPherson |
| collection | DOAJ |
| description | <p><strong>Introduction</strong>: Local antimicrobial delivery via calcium sulfate
(CaSO<span class="inline-formula"><sub>4</sub></span>) beads is used as an adjunctive treatment for periprosthetic
joint infection. There is limited clinical information describing the
performance of antimicrobial-loaded CaSO<span class="inline-formula"><sub>4</sub></span> (ALCS) in large-scale applications. We developed a simulated large joint model to study properties
of eluting ALCS. <strong>Methods</strong>: The in vitro testing platform was an adapted
standardized model for tribological testing of prosthetic total hips and
total knees (ASTM F732). The model was 70 mL total fluid volume, 25 % bovine serum, and 75 % phosphate-buffered saline, using ISO standard 14242-1 for human synovial fluid simulation. Four brands of CaSO<span class="inline-formula"><sub>4</sub></span> were
evaluated. Each 10 mL of CaSO<span class="inline-formula"><sub>4</sub></span> was loaded with 1.2 grams (g) of tobramycin and 1 g of vancomycin powders. A 35 mL bead volume, equaling 175 beads, of each product was placed in incubated flasks. The test period was 6 weeks with scheduled interval fluid exchanges. Fluid samples were tested
for antibiotic and calcium concentrations and pH. <strong>Results</strong>: Antibiotic elution showed an initial burst on Day 1, followed by a logarithmic
reduction over 1 week. Tobramycin fully eluted within 2.5 weeks. Vancomycin showed sustained release over 6 weeks. Calcium ion concentrations were high, with gradual decrease after 3 weeks. All four CaSO<span class="inline-formula"><sub>4</sub></span> products
were inherently acidic. Fluid became more acidic with the addition of
antibiotics primarily driven by vancomycin. <strong>Discussion</strong>: Clinicians should be
cognizant of tobramycin elution burst with ALCS in large loads. The main
driver of acidic pH levels was vancomycin. We propose that joint
complications may result from lowered fluid acidity, and we suggest clinical study of synovial pH.</p> |
| first_indexed | 2024-04-12T14:58:17Z |
| format | Article |
| id | doaj.art-b0221b45c78f43848f795729d0258490 |
| institution | Directory Open Access Journal |
| issn | 2206-3552 |
| language | English |
| last_indexed | 2024-04-12T14:58:17Z |
| publishDate | 2022-05-01 |
| publisher | Copernicus Publications |
| record_format | Article |
| series | Journal of Bone and Joint Infection |
| spelling | doaj.art-b0221b45c78f43848f795729d02584902022-12-22T03:28:10ZengCopernicus PublicationsJournal of Bone and Joint Infection2206-35522022-05-01711712510.5194/jbji-7-117-2022Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beadsE. J. McPherson0J. A. Jennings1O. Yunis2M. A. Harris3M. V. Dipane4N. L. Curtin5M. Chowdhry6A. J. Wassef7J. D. Bumgardner8S. P. Noel9Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, 90404, USADepartment of Biomedical Engineering, University of Memphis, Memphis, 38152, USADepartment of Biomedical Engineering, University of Memphis, Memphis, 38152, USADepartment of Biomedical Engineering, University of Memphis, Memphis, 38152, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, 90404, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, 90404, USANuffield Department of Primary Care Health Sciences, Kellogg College, University of Oxford, Oxford, OX1 2JD, UKLong Beach Lakewood Orthopedic Institute, Long Beach, 90808, USADepartment of Biomedical Engineering, University of Memphis, Memphis, 38152, USAAustin Medical Ventures, Germantown, 38138, USA<p><strong>Introduction</strong>: Local antimicrobial delivery via calcium sulfate (CaSO<span class="inline-formula"><sub>4</sub></span>) beads is used as an adjunctive treatment for periprosthetic joint infection. There is limited clinical information describing the performance of antimicrobial-loaded CaSO<span class="inline-formula"><sub>4</sub></span> (ALCS) in large-scale applications. We developed a simulated large joint model to study properties of eluting ALCS. <strong>Methods</strong>: The in vitro testing platform was an adapted standardized model for tribological testing of prosthetic total hips and total knees (ASTM F732). The model was 70 mL total fluid volume, 25 % bovine serum, and 75 % phosphate-buffered saline, using ISO standard 14242-1 for human synovial fluid simulation. Four brands of CaSO<span class="inline-formula"><sub>4</sub></span> were evaluated. Each 10 mL of CaSO<span class="inline-formula"><sub>4</sub></span> was loaded with 1.2 grams (g) of tobramycin and 1 g of vancomycin powders. A 35 mL bead volume, equaling 175 beads, of each product was placed in incubated flasks. The test period was 6 weeks with scheduled interval fluid exchanges. Fluid samples were tested for antibiotic and calcium concentrations and pH. <strong>Results</strong>: Antibiotic elution showed an initial burst on Day 1, followed by a logarithmic reduction over 1 week. Tobramycin fully eluted within 2.5 weeks. Vancomycin showed sustained release over 6 weeks. Calcium ion concentrations were high, with gradual decrease after 3 weeks. All four CaSO<span class="inline-formula"><sub>4</sub></span> products were inherently acidic. Fluid became more acidic with the addition of antibiotics primarily driven by vancomycin. <strong>Discussion</strong>: Clinicians should be cognizant of tobramycin elution burst with ALCS in large loads. The main driver of acidic pH levels was vancomycin. We propose that joint complications may result from lowered fluid acidity, and we suggest clinical study of synovial pH.</p>https://jbji.copernicus.org/articles/7/117/2022/jbji-7-117-2022.pdf |
| spellingShingle | E. J. McPherson J. A. Jennings O. Yunis M. A. Harris M. V. Dipane N. L. Curtin M. Chowdhry A. J. Wassef J. D. Bumgardner S. P. Noel Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads Journal of Bone and Joint Infection |
| title | Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads |
| title_full | Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads |
| title_fullStr | Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads |
| title_full_unstemmed | Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads |
| title_short | Simulated large joint fluid model for evaluating intra-articular antibiotic delivery systems: initial evaluation using antibiotic-loaded calcium sulfate beads |
| title_sort | simulated large joint fluid model for evaluating intra articular antibiotic delivery systems initial evaluation using antibiotic loaded calcium sulfate beads |
| url | https://jbji.copernicus.org/articles/7/117/2022/jbji-7-117-2022.pdf |
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