Prophylaxis and treatment of infection in long bones using an antibiotic-loaded ceramic coating with interlocking intramedullary nails

Emilie-Ann Downey; Kayla M Jaime; Taylor J Reif; Asim M Makhdom; S Robert Rozbruch; Austin T Fragomen

doi:10.5194/jbji-7-101-2022

Prophylaxis and treatment of infection in long bones using an antibiotic-loaded ceramic coating with interlocking intramedullary nails

J Bone Jt Infect. 2022 Apr 22;7(2):101-107. doi: 10.5194/jbji-7-101-2022. eCollection 2022.

Authors

Emilie-Ann Downey^{1

2}, Kayla M Jaime², Taylor J Reif², Asim M Makhdom³, S Robert Rozbruch², Austin T Fragomen²

Affiliations

¹ Department of Orthopaedics, Pierre-Boucher Hospital, Longueuil, QC, Canada.
² Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Cornell Medicine, Cornell University, New York, NY, USA.
³ Department of Orthopaedics, King Abdulaziz University, Jeddah, Saudi Arabia.

Abstract

Background: The study was done (1) to report on our recent experience with antibiotic-loaded calcium sulfate-coated interlocking intramedullary nails (CS-IMN) for infection prevention or infection eradication and (2) to compare the efficacy of CS-IMN versus antibiotic-loaded polymethylmethacrylate-coated IMN (PMMA-IMN) for infection eradication. Methods: We retrospectively reviewed the medical records of consecutive patients who underwent a limb salvage procedure for infection cure or infection prevention with PMMA-IMN or CS-IMN. We reviewed patient demographics, host-type, pre-operative infecting organisms, intraoperative cultures, as well as our main outcomes: infection control rate, achievement of union/fusion, and limb salvage. Results: 33 patients were treated with CS-IMN: 9 patients with goal of infection cure and 24 patients for infection prophylaxis. When used for infection prophylaxis, there was a 100 % ( $24 / 24$ patients) prevention of infection rate, 95.5 % union rate ( $21 / 22$ patients), and 100 % ( $24 / 24$ patients) limb salvage rate. Nine patients were treated with CS-IMN to eradicate infection and were compared to a cohort of 28 patients who were treated with PMMA-IMN. The infection was eradicated in $7 / 9$ patients (77.8 %) in the CS-IMN group versus 21/26 patients (80 %) in the PMMA-IMN group ( $p = 0.44$ ). Bone union/fusion was achieved in $8 / 9$ patients (88.9 %) in the CS-IMN group versus 21/24 patients (87.5 %) in the PMMA-IMN group ( $p = 0.11$ ). The limb salvage rate in the CS-IMN group was 100 % ( $9 / 9$ patients) versus 89 % ( $25 / 28$ patients) in the PMMA-IMN group. Conclusions: CS-IMN are safe and easy to use, and we have therefore expended our indications for them. CS-IMN are very effective at infection prophylaxis in high-risk cases where infection is suspected. Early analysis suggests that CS-IMN are non-inferior to PMMA-IMN for infection eradication. This is our preliminary data that show this novel technique to be safe in a small cohort and may be as effective as the more established method. Future studies with larger cohorts of patients will be required to confirm these findings.