Surgery - Implants

1
Surgery - Implants

• Polished implants - thick fibrous capsule that
  does not adhere to implants
• Textured implants - fibrous cells adhere tightly
  to implants

2
Surgery - Implants

• Microtexture promotes cellular attachment
• Burnett DM. Exp Cell Research 1641986
• Once tissue attachment achieved, bacterial
  progression retarded
• Myojin K. Biomed Metal Research 121978

3
Surgery - Implants

• Polished dense material resist acute bacterial
  infections
• Polished material required 40x greater bacterial
  load to establish infection vs. porous implant
• Cordero J et al. JBJS 76Br717,1994
• Merritt K. J Biomed Material Research 13101,1979

4
Implants

• the race for the surface
• Gristina AG. Science 2371588,1987
• Tissue integration
• Implant
• Colonize ?? infection

5
Surgery - Implants

• Colonization - Moussa FW Am. Journal Ortho
  26617,1997
• Elective implant removal cultures - 10positive
  in 21 pts
• Colonization can occur without sepsis

6
Surgery - Implants

• Melcher Ga et al. Injury 27SC3-26, 1996
• In an inoculated infection model in rabbits
• Titanium implants lower infection rate than ss
• Solid IMN lower infection rate than cannulated
• Reaming increased infection rates
• Implants may matter
• ? Statistically significant, clinically
  insignificant

7
Surgery - Stable Implants

• Merritt K Dowd JD. J Ortho Res 523,1987
• Contaminated rodent osteotomy
• Infection rate
• Unstabilized (71)
• Stabilized - IMN (38)
• Worlock P. et al. Injury 2531,1994
• Fracture - plate infection - 71
• Fracture - IMN infection - 35

8
Surgery - ImplantsSummary

• In a contaminated wound, implants that are
• polished
• solid
• titanium
• unreamed
• may be advantageous in preventing infection