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Surgery - Implants

Surgery - Implants. Polished implants - thick fibrous capsule that does not adhere to implants : Textured implants - fibrous cells adhere tightly to implants. Surgery - Implants. Microtexture promotes cellular attachment Burnett DM. Exp Cell Research 164:1986

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Surgery - Implants

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  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 164:1986 • Once tissue attachment achieved, bacterial progression retarded Myojin K. Biomed Metal Research 12:1978

  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 76Br:717,1994 Merritt K. J Biomed Material Research 13:101,1979

  4. Implants “the race for the surface” Gristina AG. Science 237:1588,1987 Tissue integration Implant Colonize ? infection

  5. Surgery - Implants Colonization - Moussa FW Am. Journal Ortho 26:617,1997 • Elective implant removal cultures - 10%positive in 21 pts • Colonization can occur without sepsis

  6. Surgery - Implants Melcher Ga et al. Injury 27:SC3-26, 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 5:23,1987 • Contaminated rodent osteotomy • Infection rate • Unstabilized (71%) • Stabilized - IMN (38%) Worlock P. et al. Injury 25:31,1994 • 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

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