Bioactive-Coated Implants in Trauma Surgery

Abstract

Complications still occur in musculoskeletal surgery despite improvements in operating techniques and optimization of implants. Problems include delayed fracture healing, non-unions and extensive osseous infections. Growth factors for local application are in clinical use, but have not become widely accepted. Reasons may be that these proteins are expensive and of limited availability and considerable quantities have to be implanted locally. Coated implants incorporating active ingredients could release drugs locally and thereby generate a high concentration directly in the area of interest without systemic side effects. Compounds that could be used in this way include growth factors for the improvement of fracture healing and antibiotics for prophylaxis of implant-related infections. The biodegradable poly(D,L-lactide) coating of implants can facilitate the local controlled release of incorporated growth factors directly into the fracture and thus serves both as a fracture stabilization device and as a carrier for active components. This review presents different models (fracture healing; intervertebral fusion; infection model) demonstrating the efficiency of the coating technology. These findings seem to justify the transfer of this technology into clinical settings. In a preliminary study, gentamicin-coated intramedullary tibial nails were implanted in patients exhibiting fractures with severe soft tissue damage. The preliminary findings do not allow conclusions to be drawn in respect of therapy of fractures with severe soft tissue damage or revision surgery. However, the coating seems to be suitable as a “key technology” for the incorporation of active ingredients and might be helpful in revision arthroplasty.