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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 11, 1430-1437.
doi: 10.1302/0301-620X.88B11.18335  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Iontophoresed segmental allografts in revision arthroplasty for infection

K. A. Michalak, BE, Bioengineer1; P. P. C. Khoo, MB BS, Orthopaedic Registrar2; P. J. Yates, MRCS, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon and Senior Lecturer2; R. E. Day, CPEng(Biomed), Bioengineer1; and D. J. Wood, MS, FRCS, FRACS, Professor of Orthopaedic Surgery3

1 Medical Engineering and Physics Department, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6847, Australia.
2 Department of Orthopaedics and Trauma, Fremantle Hospital, Alma Street, Fremantle, Western Australia 6160, Australia.
3 Perth Orthopaedic Institute, Verdun Street, Nedlands, Perth, Western Australia 6009, Australia.

Correspondence should be sent to Mr P. J. Yates; e-mail: piersyates{at}hotmail.com

Revision arthroplasty after infection can often be complicated by both extensive bone loss and a relatively high rate of re-infection. Using allograft to address the bone loss in such patients is controversial because of the perceived risk of bacterial infection from the use of avascular graft material. We describe 12 two-stage revisions for infection in which segmental allografts were loaded with antibiotics using iontophoresis, a technique using an electrical potential to drive ionised antibiotics into cortical bone.

Iontophoresis produced high levels of antibiotic in the allograft, which eluted into the surrounding tissues. We postulate that this offers protection from infection in the high-risk peri-operative period. None of the 12 patients who had two-stage revision with iontophoresed allografts had further infection after a mean period of 47 months (14 to 78).




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H. Winkler, A. Stoiber, K. Kaudela, F. Winter, and F. Menschik
One stage uncemented revision of infected total hip replacement using cancellous allograft bone impregnated with antibiotics
J Bone Joint Surg Br, December 1, 2008; 90-B(12): 1580 - 1584.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General