Implant-related infection is one of the leading reasons for failure in orthopaedics and trauma, and results in high social and economic costs. Various antibacterial coating technologies have proven to be safe and effective both in preclinical and clinical studies, with post-surgical implant-related infections reduced by 90% in some cases, depending on the type of coating and experimental setup used. Economic assessment may enable the cost-to-benefit profile of any given antibacterial coating to be defined, based on the expected infection rate with and without the coating, the cost of the infection management, and the cost of the coating. After reviewing the latest evidence on the available antibacterial coatings, we quantified the impact caused by delaying their large-scale application. Considering only joint arthroplasties, our calculations indicated that for an antibacterial coating, with a final user’s cost price of €600 and able to reduce post-surgical infection by 80%, each year of delay to its large-scale application would cause an estimated 35 200 new cases of post-surgical infection in Europe, equating to additional hospital costs of approximately €440 million per year. An adequate reimbursement policy for antibacterial coatings may benefit patients, healthcare systems, and related research, as could faster and more affordable regulatory pathways for the technologies still in the pipeline. This could significantly reduce the social and economic burden of implant-related infections in orthopaedics and trauma.
The treatment of chronic osteomyelitis often
includes surgical debridement and filling the resultant void with antibiotic-loaded
polymethylmethacrylate cement, bone grafts or bone substitutes.
Recently, the use of bioactive glass to treat bone defects in infections
has been reported in a limited series of patients. However, no direct comparison
between this biomaterial and antibiotic-loaded bone substitute has
been performed. In this retrospective study, we compared the safety and efficacy
of surgical debridement and local application of the bioactive glass
S53P4 in a series of 27 patients affected by chronic osteomyelitis
of the long bones (Group A) with two other series, treated respectively
with an antibiotic-loaded hydroxyapatite and calcium sulphate compound
(Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded
demineralised bone matrix (Group C; n = 22). Systemic antibiotics
were also used in all groups. After comparable periods of follow-up, the control of infection
was similar in the three groups. In particular, 25 out of 27 (92.6%)
patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out
of 22 (86.3%) in Group C showed no infection recurrence at means
of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up,
respectively, while Group A showed a reduced wound complication
rate. Our results show that patients treated with a bioactive glass
without local antibiotics achieved similar eradication of infection
and less drainage than those treated with two different antibiotic-loaded
calcium-based bone substitutes. Cite this article:
