Orthopedic post-operative infections rank high on the list of feared surgical complications. Rectifying these infections often requires replacing the implant in complex, expensive procedures with no guarantee of success. These bacterial infections form a biofilm, a protective layer of proteins on the implant’s surface, which makes them impermeable to antibiotics. Consequently, patients may undergo multiple surgeries to remove and replace the affected implant, and those who are immunocompromised, elderly, or less privileged financially bear a higher infection risk.
Dr. Nicholas M. Bernthal, a specialist in pediatric orthopedic oncology, knows this risk all too well. He recounts the unfairness of children overcoming exhaustive chemotherapy and intricate surgeries, only to fall victim to debilitating infections. Despite successfully treating cancer through extensive removal and replacement of bone fragments with implants, these children often deal with lifelong battles against persistent infections. However, a cutting-edge, point-of-care solution developed at the University of California Los Angeles (UCLA) might hold the key to making these implant-associated infections a thing of the past.
Implant-associated infections are not uncommon, affecting one out of every hundred patients undergoing hip or knee replacement surgeries. This comes with a hefty price tag, costing the U.S healthcare system billions. Dr. Bernthal highlights that these numbers soar dramatically in healthcare systems worldwide that lack resources dedicated to sterility, patient optimization, and modern implants. Determined to find a solution, Dr. Bernthal collaborated with biomedical engineer Professor Tatiana Segura and a team of engineers at UCLA.
This group aimed at devising a prevention strategy that would not alter the implant manufacturing process to avoid new regulatory scrutiny and extend the product’s expiry. They also envisioned a customizable solution, recognizing that infection risks vary based on different environmental and patient factors. Finally, the team was determined that their strategy must be user-friendly, allowing surgeons fast preparation and application during surgeries. Their answer lay in a surface modification platform that surgeons could apply to implants during operations to halt or slow down the spread of infectious microorganisms.
Using an approach known as ‘click’ chemistry (swift reactions happening at room temperature), the surgeons can now mix two polymers with their selected antibiotic or antimicrobial. The result is a product that they can apply directly to the implant by simply dipping, painting, or spraying it. A study led by Dr. Bernthal and Professor Segura and published in Nature Communications, confirmed that this antimicrobial coating applied to implants successfully averted infections in every mouse model of their testing.
As the research team progresses to clinical trials, awaiting approval from the U.S. Food and Drug Administration, there’s optimism that the surface modification approach can prevent infections effectively. Nonetheless, Dr. Bernthal is a staunch advocate for a comprehensive strategy. For instance, his lab contributed to developing an antibody in Phase I/II clinical trials to treat resistant implant infections. Meanwhile, he leads a consortium focused on enhancing patients’ immunity to pathogens before surgery.
Even with these advancements, Dr. Bernthal asserts that no singular solution can completely eliminate the risk of infections. His comprehensive approach encompasses optimizing patient immunity through immunomodulation, reengineering implants to serve as antimicrobial weapons, and developing antibody-based treatments for infections that breach these safeguards. He concludes that this multifaceted strategy could edge the infection risk percentage tantalizingly close to zero.
Source: https://www.uclahealth.org/news/orthopedic-implant-infection-solution