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Efficacy of a porous‐structured titanium subdermal barrier for preventing infection in percutaneous osseointegrated prostheses
Author(s) -
Jeyapalina Sujee,
Beck James Peter,
Bachus Kent N.,
Williams Dustin L.,
Bloebaum Roy D.
Publication year - 2012
Publication title -
journal of orthopaedic research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.041
H-Index - 155
eISSN - 1554-527X
pISSN - 0736-0266
DOI - 10.1002/jor.22081
Subject(s) - osseointegration , implant , medicine , percutaneous , surgery , periprosthetic , dentistry , biomedical engineering , arthroplasty
Infections of percutaneous osseointegrated prostheses (POP) cause prolonged morbidity and device failure because once established, they are refractory to antibiotic therapy. To date, only limited translational animal studies have investigated the efficacy of POP designs in preventing infections. We developed an animal model to evaluate the efficacy of a porous‐coated titanium (Ti) subdermal barrier to achieve skin–implant integration and to prevent periprosthetic infection. In a single‐stage “amputation and implantation” surgery, 14 sheep were fitted with percutaneous devices with an attached porous‐coated Ti subdermal barrier. Nine sheep were implanted with a smooth Ti subdermal barrier construct and served as controls, with one control sheep removed from the study due to a fractured bone. Clinical, microbiological, and histopathological data showed that the porous Ti barrier prevented superficial and deep tissue infections in all animals (14/14, 100%) at the 9‐month endpoint. In contrast, animals with the smooth Ti implant construct had a 25% (2/8) infection rate. Survival analysis indicated a significant difference between the groups (log‐rank test, p = 0.018). Data also indicated that although skin marsupialization was evident in both implant types, animals in the control group had a four times greater marsupialization rate. We concluded that osseointegrated implants incorporating porous‐coated Ti subdermal barriers may have the ability to prevent infection by maintaining a healthy, biologically attached epithelial barrier at the skin–implant interface in load‐bearing animals up to a 9‐month terminus. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1304–1311, 2012