The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique
Background:. Surgeons performing the induced membrane technique (IMT) often incorporate antibiotics into the spacer at the first stage of the surgical procedure to prevent or treat infection. However, the effect of antibiotic use on subsequent bone healing is not clear. This study aimed to investiga...
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Wolters Kluwer
2025-03-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00059 |
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| author | Hening Sun, MSc Charles Godbout, PhD Gareth Ryan, MD Ikran Ali, PhD James Higgins, MD Graeme Hoit, MD Jeremy Hall, MD Mansur Halai, MD Amir Khoshbin, MD Emil H. Schemitsch, MD Aaron Nauth, MD, MSc |
| author_facet | Hening Sun, MSc Charles Godbout, PhD Gareth Ryan, MD Ikran Ali, PhD James Higgins, MD Graeme Hoit, MD Jeremy Hall, MD Mansur Halai, MD Amir Khoshbin, MD Emil H. Schemitsch, MD Aaron Nauth, MD, MSc |
| author_sort | Hening Sun, MSc |
| collection | DOAJ |
| description | Background:. Surgeons performing the induced membrane technique (IMT) often incorporate antibiotics into the spacer at the first stage of the surgical procedure to prevent or treat infection. However, the effect of antibiotic use on subsequent bone healing is not clear. This study aimed to investigate if antibiotic-impregnated spacers impact subsequent bone healing in a rat model of the IMT.
Methods:. Inbred male rats (Fischer 344) were randomly divided into 3 groups according to the antibiotic dose in the spacer: (1) control (no antibiotics), (2) low-dose (1.2 g tobramycin and 1.0 g vancomycin per 40 g of polymethylmethacrylate [PMMA]), and (3) high-dose (3.6 g tobramycin and 3.0 g vancomycin per 40 g of PMMA). We created a 5-mm segmental defect in the right femoral diaphysis. The bone was stabilized with a plate and screws, and the assigned spacer was inserted into the defect. Four weeks later, the spacer was removed and bone graft was placed within the defect. Radiographs made 12 weeks after grafting were scored according to union status and degree of bone healing. Micro-computed tomographic (CT) analysis and biomechanical testing were also performed at 12 weeks.
Results:. Full radiographic union was achieved in 10 (83%) of 12 control animals, 13 (100%) of 13 low-dose animals, and 8 (62%) of 13 high-dose animals (high-dose compared with low-dose: risk ratio, 11.0; p = 0.039). The control group demonstrated higher bone volume compared with the high-dose group (mean difference, 9.0 mm3; p = 0.039), and there was a trend toward higher bone volume in the low-dose group compared with the high-dose group (mean difference, 8.1 mm3; p = 0.06). The biomechanical results demonstrated that maximum stiffness was significantly higher in the low-dose group compared with the high-dose group (mean difference, 14.1 N*mm/degree; p = 0.009).
Conclusions:. Our results demonstrated that low doses of antibiotics in PMMA spacers used for the IMT did not impair bone healing. However, high doses of antibiotics demonstrated inferior bone healing.
Clinical Relevance:. The addition of high-dose antibiotics to the PMMA spacers used for the IMT may result in impaired bone healing and should be used with caution. |
| format | Article |
| id | doaj-art-aee7b6ee32554ac6beeff175a2119cc6 |
| institution | OA Journals |
| issn | 2472-7245 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj-art-aee7b6ee32554ac6beeff175a2119cc62025-08-20T02:03:35ZengWolters KluwerJBJS Open Access2472-72452025-03-0110110.2106/JBJS.OA.24.00059JBJSOA2400059The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane TechniqueHening Sun, MSc0Charles Godbout, PhD1Gareth Ryan, MD2Ikran Ali, PhD3James Higgins, MD4Graeme Hoit, MD5Jeremy Hall, MD6Mansur Halai, MD7Amir Khoshbin, MD8Emil H. Schemitsch, MD9Aaron Nauth, MD, MSc101 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada3 Division of Orthopaedic Surgery, Department of Surgery, University of Western Ontario, London, Ontario, Canada1 Division of Orthopaedic Surgery, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, CanadaBackground:. Surgeons performing the induced membrane technique (IMT) often incorporate antibiotics into the spacer at the first stage of the surgical procedure to prevent or treat infection. However, the effect of antibiotic use on subsequent bone healing is not clear. This study aimed to investigate if antibiotic-impregnated spacers impact subsequent bone healing in a rat model of the IMT. Methods:. Inbred male rats (Fischer 344) were randomly divided into 3 groups according to the antibiotic dose in the spacer: (1) control (no antibiotics), (2) low-dose (1.2 g tobramycin and 1.0 g vancomycin per 40 g of polymethylmethacrylate [PMMA]), and (3) high-dose (3.6 g tobramycin and 3.0 g vancomycin per 40 g of PMMA). We created a 5-mm segmental defect in the right femoral diaphysis. The bone was stabilized with a plate and screws, and the assigned spacer was inserted into the defect. Four weeks later, the spacer was removed and bone graft was placed within the defect. Radiographs made 12 weeks after grafting were scored according to union status and degree of bone healing. Micro-computed tomographic (CT) analysis and biomechanical testing were also performed at 12 weeks. Results:. Full radiographic union was achieved in 10 (83%) of 12 control animals, 13 (100%) of 13 low-dose animals, and 8 (62%) of 13 high-dose animals (high-dose compared with low-dose: risk ratio, 11.0; p = 0.039). The control group demonstrated higher bone volume compared with the high-dose group (mean difference, 9.0 mm3; p = 0.039), and there was a trend toward higher bone volume in the low-dose group compared with the high-dose group (mean difference, 8.1 mm3; p = 0.06). The biomechanical results demonstrated that maximum stiffness was significantly higher in the low-dose group compared with the high-dose group (mean difference, 14.1 N*mm/degree; p = 0.009). Conclusions:. Our results demonstrated that low doses of antibiotics in PMMA spacers used for the IMT did not impair bone healing. However, high doses of antibiotics demonstrated inferior bone healing. Clinical Relevance:. The addition of high-dose antibiotics to the PMMA spacers used for the IMT may result in impaired bone healing and should be used with caution.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00059 |
| spellingShingle | Hening Sun, MSc Charles Godbout, PhD Gareth Ryan, MD Ikran Ali, PhD James Higgins, MD Graeme Hoit, MD Jeremy Hall, MD Mansur Halai, MD Amir Khoshbin, MD Emil H. Schemitsch, MD Aaron Nauth, MD, MSc The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique JBJS Open Access |
| title | The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique |
| title_full | The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique |
| title_fullStr | The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique |
| title_full_unstemmed | The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique |
| title_short | The Effects of Antibiotic-Impregnated Spacers on Bone Healing in an Animal Model of the Induced Membrane Technique |
| title_sort | effects of antibiotic impregnated spacers on bone healing in an animal model of the induced membrane technique |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00059 |
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