7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 1/18

 THE MANAGEMENT OFPERIPROSTHETIC INFECTION

IN THE FUTUREA REVIEW OF NEW FORMS OF TREATMENT

D. A. George, V. Gant, F. S. Haddad THE BONE & OINT OURNA!, SEPTEMBER "#$%

dr. W. H'() S*'a(an

dr. Pand* An*gra+an, SOT

RSUD Pro-n Banten

"#$%

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 2/18

PRO!OGUE

•  T/e n*(0er o1 art/ro'ate 0eng*nderta2en e3e4ted to gro+ )ear on)ear.

• Dete (an) ntat-e to red*4e t o-ert/e )ear, t/e rate o1 errot/et4 5ontn1e4ton 6PI7 re(an at $89"8.

• Mot 4o((on at/ogen: S. Aureus

 – Ad/ere to t/e rot/e, d*'4ate,4o'one.

 – Be4o(e retant to ant0ot4.

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 3/18

PRO!OGUE

• Bo;'(:

 – Po')etde

 – Po')a44/arde

 – N*4'e4 a4d

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 4/18

PATIENTS AND METHODS

• Re-e+ed a'' aer +t/ a 1*'' te3t or ana0tra4t n Eng'/ +/4/ *0'/ed1ro( $<=# to *ne "#$>.

• Internatona' data0aed t/at *ed 1or t/ 5o*rna': – P*0Med?Med'ne

 – EMBASE

 – ot/er

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 5/18

PATIENTS AND METHODSKEYWORDS USED DURING THE INITIAL AND EXPANDED

LITERATURE SEARCH

INITIAL SEARCH EXPANDED SEARCH

Perrot/et4 5ont n1e4ton P/otod)na(4 t/era)

I('ant n1e4ton Meta' on

Prot/e n1e4ton Nanoart4'eH n1e4ton Magnet4 ;e'd

@nee n1e4ton E'e4tr4 ;e'd

S/o*'der n1e4ton

F*t*re

Patent

Mod;4aton

 T/eatre

 Te4/n*e

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 6/18

RESU!TS

$. T/eatre (od;4aton

". Oerat-e (od;4aton

. Mod;4aton o1 rot/ee>. Ant0ot4 rot/et4 4oatng

%. Ant0o;'( rot/et4 4oatng

. Intra9oerat-e a'ed t/erae=. E3terna' ant(4ro0a' t/era)

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 7/18

 THEATRE MODIFICATIONS

• Preen4e o1 ;-e eo'e: n4reae t/e0a4tera' 4o*nt 0) > t(e 61ro( 2n,rerator) art4'e, /ar, 4'ot/ng7

• !a(nar o+

• UV 'g/t

• Ster'ng t/e oeratng roo( 0et+eenatent or o-erng/t

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 8/18

OPERATIVE MODIFICATIONS

• Pro/)'a4t4 )te(4 ant0ot4

• Ant0ot4 (regnated 4e(ent

•

P*'at'e 'a-age• Ant0ot4 (regnated 'at4 ad/e-e

drae

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 9/18

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 10/18

MODIFICATIONS OF

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 11/18

MODIFICATIONS OFPROSTHESES

• Str*4t*re o1 t/e rot/e

 – S*r1a4e

 – Te3t*re

 – H)dro/o04t)

• Ion t/at *ed 1or (od;4aton

 –

S'-er – n2

 – Iron

 – Ttan*(

 – Car0on

ANTIBIOTICS PROSTHETIC

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 12/18

ANTIBIOTICS PROSTHETICCOATINGS

• Van4o()4n

• Genta(4n

•

Ce1tra3one• @ana()4n

•  Tetra4)4'ne

•

Do3)4)4'ne• !e-oo3a4n

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 13/18

ANTIBIOFI!M PROSTHETIC COATINGS

• Deo3)r0on*4'eae 6Dnae7 $ – Degrade e3tra4e''*'ar DNA, 2no+n to

4a*e ;r(ne and ta0't) o1 t/e

0o;'( and n/0t 0o;'( 1or(aton,(a2ng t (ore *4et0'e to -aro*ant0ot4.

•

Dern B – Target nter4e''*'ar ad/eon rod*4ed

0) t/e 0o;'(.

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 14/18

INTRA OPERATIVE APP!IED THERAPIES

• Can4e''o* a''ogra1t 0one(regnated +t/ ant0ot4. – Genta(4n

 – Ca'4*( *'/ate ant0ot46-an4o()4n7

ETERNA! ANTIMICROBIA!

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 15/18

ETERNA! ANTIMICROBIA! THERAP

• P/otod)na(4 t/era) 6PDT7

• Magnet4 and e'e4tr4 ;e'd – C/arge nanot*0*'ar ttan*( *ng a

-o'tage o1 $% to # -o't  de4reae1or(aton o1 0o;'(

• S/o42+a-e treat(ent

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 16/18

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 17/18

EPI!OGUE

• Ba4tera 4annot 0e 1*'') erad4ated1ro( t/e 2n. S. Aureus a /*(an4o((ena', addng t/e r2 o1 n1e4ton

to e-er) n4on, dete 2nante.

•  T/e tet de(ontrate t/at 0a4tera 4an

ad/ere to t/e *r1a4e o1 t/e rot/e,0*t not *4ent to 4a*e n1e4ton.

7/23/2019 The Management of Periprosthetic Infection in the Future

http://slidepdf.com/reader/full/the-management-of-periprosthetic-infection-in-the-future 18/18

J&A

• Dr. Ae SBS  ta('2an d*'*a0tra2n)a. ang d0ag2an 2e eertaada'a/ 1*'' te3t, 5angan t. 52a ada

n1e2, 0aga(ana tata 'a2anan)aK – 2a 0e'*( ada ('an 1a'*re, AB d*'*.

• dr. 0ernard  Ant0ot2 4oatng &

ant0o;'( 4oatng *da/ ada ata*0e'*(K – Ant0o;'( (a/ +a4ana.