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Iontophoresis as a means of delivering antibiotics into allograft bone

¹ Department of Medical Engineering and Physics Royal Perth Hospital, Wellington Street, Perth 6001, Western Australia, Australia.
² Pioneer Valley Private Hospital, Norris Road, Makay 4740, Queensland, Australia.
³ Department of Orthopaedic Surgery, University of Western Australia, Perth, Western Australia, Australia.

Correspondence should be sent to Mr R. E. Day at Department of Medical Engineering and Physics, Royal Perth Hospital, GPO Box X2213, Perth 6847, Western Australia, Australia; e-mail: robert.day{at}health.wa.gov.uu

Allograft bone is widely used in orthopaedic surgery, but peri-operative infection of the graft remains a common and disastrous complication. The efficacy of systemic prophylactic antibiotics is unproven, and since the graft is avascular it is likely that levels of antibiotic in the graft are low.

Using an electrical potential to accelerate diffusion of antibiotics into allograft bone, high levels were achieved in specimens of both sheep and human allograft. In human bone these ranged from 187.1 mg/kg in endosteal (SD 15.7) to 124.6 (SD 46.2) in periosteal bone for gentamicin and 31.9 (SD 8.9) in endosteal and 2.9 (SD 1.1) in periosteal bone for flucloxacillin. The antibiotics remained active against bacteria in vitro after iontophoresis and continued to elute from the allograft for up to two weeks.

Structural allograft can be supplemented directly with antibiotics using iontophoresis. The technique is simple and inexpensive and offers a potential means of reducing the rate of peri-operative infection in allograft surgery. Iontophoresis into allograft bone may also be applicable to other therapeutic compounds.

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				K. A. Michalak, P. P. C. Khoo, P. J. Yates, R. E. Day, and D. J. Wood Iontophoresed segmental allografts in revision arthroplasty for infection J Bone Joint Surg Br, November 1, 2006; 88-B(11): 1430 - 1437. [Abstract] [Full Text] [PDF]

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