the management of periprosthetic infection in the future
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THE MANAGEMENT OFPERIPROSTHETIC INFECTION
IN THE FUTUREA REVIEW OF NEW FORMS OF TREATMENT
D. A. George, V. Gant, F. S. Haddad THE BONE & OINT OURNA!, SEPTEMBER "#$%
dr. W. H'() S*'a(an
dr. Pand* An*gra+an, SOT
RSUD Pro-n Banten
"#$%
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PRO!OGUE
• T/e n*(0er o1 art/ro'ate 0eng*nderta2en e3e4ted to gro+ )ear on)ear.
• Dete (an) ntat-e to red*4e t o-ert/e )ear, t/e rate o1 errot/et4 5ontn1e4ton 6PI7 re(an at $89"8.
• Mot 4o((on at/ogen: S. Aureus
– Ad/ere to t/e rot/e, d*'4ate,4o'one.
– Be4o(e retant to ant0ot4.
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PRO!OGUE
• Bo;'(:
– Po')etde
– Po')a44/arde
– N*4'e4 a4d
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PATIENTS AND METHODS
• Re-e+ed a'' aer +t/ a 1*'' te3t or ana0tra4t n Eng'/ +/4/ *0'/ed1ro( $<=# to *ne "#$>.
• Internatona' data0aed t/at *ed 1or t/ 5o*rna': – P*0Med?Med'ne
– EMBASE
– ot/er
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PATIENTS AND METHODSKEYWORDS USED DURING THE INITIAL AND EXPANDED
LITERATURE SEARCH
INITIAL SEARCH EXPANDED SEARCH
Perrot/et4 5ont n1e4ton P/otod)na(4 t/era)
I('ant n1e4ton Meta' on
Prot/e n1e4ton Nanoart4'eH n1e4ton Magnet4 ;e'd
@nee n1e4ton E'e4tr4 ;e'd
S/o*'der n1e4ton
F*t*re
Patent
Mod;4aton
T/eatre
Te4/n*e
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RESU!TS
$. T/eatre (od;4aton
". Oerat-e (od;4aton
. Mod;4aton o1 rot/ee>. Ant0ot4 rot/et4 4oatng
%. Ant0o;'( rot/et4 4oatng
. Intra9oerat-e a'ed t/erae=. E3terna' ant(4ro0a' t/era)
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THEATRE MODIFICATIONS
• Preen4e o1 ;-e eo'e: n4reae t/e0a4tera' 4o*nt 0) > t(e 61ro( 2n,rerator) art4'e, /ar, 4'ot/ng7
• !a(nar o+
• UV 'g/t
• Ster'ng t/e oeratng roo( 0et+eenatent or o-erng/t
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OPERATIVE MODIFICATIONS
• Pro/)'a4t4 )te(4 ant0ot4
• Ant0ot4 (regnated 4e(ent
•
P*'at'e 'a-age• Ant0ot4 (regnated 'at4 ad/e-e
drae
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MODIFICATIONS OF
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MODIFICATIONS OFPROSTHESES
• Str*4t*re o1 t/e rot/e
– S*r1a4e
– Te3t*re
– H)dro/o04t)
• Ion t/at *ed 1or (od;4aton
–
S'-er – n2
– Iron
– Ttan*(
– Car0on
ANTIBIOTICS PROSTHETIC
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ANTIBIOTICS PROSTHETICCOATINGS
• Van4o()4n
• Genta(4n
•
Ce1tra3one• @ana()4n
• Tetra4)4'ne
•
Do3)4)4'ne• !e-oo3a4n
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ANTIBIOFI!M PROSTHETIC COATINGS
• Deo3)r0on*4'eae 6Dnae7 $ – Degrade e3tra4e''*'ar DNA, 2no+n to
4a*e ;r(ne and ta0't) o1 t/e
0o;'( and n/0t 0o;'( 1or(aton,(a2ng t (ore *4et0'e to -aro*ant0ot4.
•
Dern B – Target nter4e''*'ar ad/eon rod*4ed
0) t/e 0o;'(.
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INTRA OPERATIVE APP!IED THERAPIES
• Can4e''o* a''ogra1t 0one(regnated +t/ ant0ot4. – Genta(4n
– Ca'4*( *'/ate ant0ot46-an4o()4n7
ETERNA! ANTIMICROBIA!
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ETERNA! ANTIMICROBIA! THERAP
• P/otod)na(4 t/era) 6PDT7
• Magnet4 and e'e4tr4 ;e'd – C/arge nanot*0*'ar ttan*( *ng a
-o'tage o1 $% to # -o't de4reae1or(aton o1 0o;'(
• S/o42+a-e treat(ent
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EPI!OGUE
• Ba4tera 4annot 0e 1*'') erad4ated1ro( t/e 2n. S. Aureus a /*(an4o((ena', addng t/e r2 o1 n1e4ton
to e-er) n4on, dete 2nante.
• T/e tet de(ontrate t/at 0a4tera 4an
ad/ere to t/e *r1a4e o1 t/e rot/e,0*t not *4ent to 4a*e n1e4ton.
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J&A
• Dr. Ae SBS ta('2an d*'*a0tra2n)a. ang d0ag2an 2e eertaada'a/ 1*'' te3t, 5angan t. 52a ada
n1e2, 0aga(ana tata 'a2anan)aK – 2a 0e'*( ada ('an 1a'*re, AB d*'*.
• dr. 0ernard Ant0ot2 4oatng &
ant0o;'( 4oatng *da/ ada ata*0e'*(K – Ant0o;'( (a/ +a4ana.