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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 9, 1149-1157.
doi: 10.1302/0301-620X.88B9.17500  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Iontophoresis of antibiotics into segmental allografts

P. P. C. Khoo, MBBS (Hons), Orthopaedic Registrar1; K. A. Michalak, BSc/BE (Hons), Bioengineer2; P. J. Yates, FRCS(Tr & Orth), Consultant Senior Lecturer3; S. M. Megson, FRACS(Orth), Orthopaedic Surgeon4; R. E. Day, MBiomedEng, Project Bioengineer2; and D. J. Wood, FRACS(Orth) FRCS, Professor of Orthopaedic Surgery5

1 Department of Orthopaedic Surgery
2 Bioengineering Division, Medical Engineering and Physics Department Royal Perth Hospital, Wellington Street Campus, Box X2213 GPO, Perth, Western Australia 6847, Australia.
3 Department of Orthopaedics and Trauma, Fremantle Hospital & The University of Western Australia, Fremantle Hospital, Level 6, Block B, Alma Street, Fremantle, Western Australia 6160, Australia.
4 Pioneer Valley Private Hospital, Norris Road, Mackay, Queensland 4740, Australia.
5 Unit of Orthopaedic Surgery University of Western Australia, Gate 3, Verdun Street, Nedlands, Western Australia 6009, Australia.

Correspondence should be sent to Ms K. A. Michalak; e-mail: michalak.kasia{at}gmail.com

Iontophoresis is a novel technique which may be used to facilitate the movement of antibiotics into the substance of bone using an electrical potential applied externally. We have examined the rate of early infection in allografts following application of this technique in clinical practice. A total of 31 patients undergoing revision arthroplasty or surgery for limb salvage received 34 iontophoresed sequential allografts, of which 26 survived for a minimum of two years. The mean serum antibiotic levels after operation were low (gentamicin 0.37 mg/l (0.2 to 0.5); flucloxacillin 1 mg/l (0 to 1) and the levels in the drains were high (gentamicin 40 mg/l (2.5 to 131); flucloxacillin 17 mg/l (1 to 43). There were no early deep infections. Two late infections were presumed to be haemotogenous; 28 of the 34 allografts were retained. In 12 patients with pre-existing proven infection further infection has not occurred at a mean follow-up of 51 months (24 to 82).






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