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Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions

ORCID
0000-0001-7309-478X
Affiliation
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
Freischmidt, Holger;
Affiliation
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
Armbruster, Jonas;
Affiliation
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
Rothhaas, Catharina;
Affiliation
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
Titze, Nadine;
Affiliation
Trauma Centre, Hospital Paulinenhilfe Stuttgart at Tübingen University Hospital, Rosenbergstr. 38, 70176 Stuttgart, Germany
Guehring, Thorsten;
ORCID
0000-0002-1278-5939
Affiliation
Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany
Nurjadi, Dennis;
ORCID
0000-0002-2779-4221
Affiliation
Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Germany
Kretzer, Jan Philippe;
Affiliation
Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
Schmidmaier, Gerhard;
ORCID
0000-0002-0730-4782
Affiliation
Department of Trauma and Orthopedic Surgery, BG Klinikum Ludwigshafen at Heidelberg University Hospital, 67071 Ludwigshafen am Rhein, Germany
Grützner, Paul Alfred;
Affiliation
Clinic for Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
Helbig, Lars

The treatment of non-unions is often complicated by segmental bone defects and bacterial colonization. Because of the limited availability of autologous bone grafts, tissue engineering focuses on antibiotic-loaded bone graft substitutes. HACaS+G is a resorbable calcium sulphate-hydroxyapatite loaded with gentamicin. The osteoinductive, osteoconductive, and anti-infective effect of HACaS+G has already been demonstrated in clinical studies on patients with chronic osteomyelitis. However, especially for the treatment of infected non-unions with segmental bone defects by HACaS+G, reliable clinical testing is difficult and sufficient experimental data are lacking. We used an already established sequential animal model in infected and non-infected rat femora to investigate the osteoinductive, osteoconductive, and anti-infective efficacy of HACaS+G for the treatment of infected non-unions. In biomechanical testing, bone consolidation could not be observed under infected and non-infected conditions. Only a prophylactic effect against infections, but no eradication, could be verified in the microbiological analysis. Using µ-CT scans and histology, osteoinduction was detected in both the infected and non-infected bone, whereas osteoconduction occurred only in the non-infected setting. Our data showed that HACaS+G is osteoinductive, but does not have added benefits in infected non-unions in terms of osteoconduction and mechanical bone stability, especially in those with segmental bone defects.

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