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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 attachmentBurnett DM. Exp Cell Research 164:1986
• Once tissue attachment achieved, bacterial progression retarded
Myojin K. Biomed Metal Research 12:1978
Surgery - Implants• Polished dense material resist acute
bacterial infections• Polished material required 40x greater
bacterial load to establish infection vs. porous implantCordero J et al. JBJS 76Br:717,1994Merritt K. J Biomed Material Research
13:101,1979
Implants
“the race for the surface”Gristina AG. Science 237:1588,1987
Tissue integrationImplant
Colonize ? infection
Surgery - ImplantsColonization - Moussa FW Am. Journal Ortho 26:617,1997
• Elective implant removal cultures - 10%positive in 21 pts
• Colonization can occur without sepsis
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
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%