Use of an amikacin-infused collagen sponge concurrent with implant removal for treatment of tibial plateau leveling osteotomy surgical site infection in 31 cases

Silver nanoparticles can be sampled by ultrafiltration probe but elution into & recovery from plasma and Dulbecco's Phosphate Buffered Saline differs in vitro

Locally sustained release antimicrobials such as silver nanoparticles (AgNPs) might prove useful in combating local infections. Their elution has been investigated in Phosphate Buffered Saline (PBS) including from poloxamer 407 (P407). No information exists on possible interactions with proteins, nor have ultrafiltration (UF) probes been evaluated to measure Ag. These investigations would provide helpful data prior to investigating the sustained release after subcutaneous implantation in vivo over time. We compared (1) the influence of elution fluid on AgNP elution, and (2) UF probe and direct sampling in vitro. Six AgNP-P407 specimens in a dialysis tube were placed in Dulbecco's PPBS (DPBS) (n = 3) or canine plasma (n = 3) for 96 h on a stirred hot plate (37 °C and 600 rpm) and sampled 20 times. A 0.001 mg/mL AgNP solution was prepared in DPBS or plasma. Six pipette and UF probe samples were taken of each. Inductively coupled plasma mass spectrometry was used to analyze Ag. Stock plasma contained Ag. At 96 h, 5/6 dialysis tubes had not fully released AgNP. One peak in hourly Ag increase was present in DPBS (10-13 h), and two peaks in plasma (6-8 and 10-13 h). The hourly Ag increase in plasma decreased earlier than in DPBS. Ultrafiltration probe sampling was possible in both DPBS and plasma and resulted in higher Ag concentrations but with more variation. While in vitro use of DPBS might be more cost effective, plasma should be considered due to difference in elution and recovery. Ultrafiltration probes can be used to sample Ag, but results will have a greater degree of variation, and multiple samples and increased time points should be considered.

Evaluation of the clinical value of routine radiographic examination during convalescence for tibial plateau-leveling osteotomy

OBJECTIVE

To determine how frequently routine follow-up radiographic findings would result in a change to the postoperative plan following tibial plateau-leveling osteotomy (TPLO) in dogs.

STUDY DESIGN

Retrospective study SAMPLE POPULATION: Short-term group: 100 cases; intermediate-term group: 50 cases.

METHODS

Medical records of 100 consecutive cases meeting the inclusion criteria were reviewed (the short-term group). The cases had no owner-perceived issues and underwent routinely prescribed radiographic follow up between 40 and 60 postoperative days after TPLO performed by one experienced surgeon. Complications identified on physical examination (PE) and radiographic examination (RE) were recorded, along with any changes to the postoperative plan. Medical records of 50 consecutive cases that had short-term and intermediate-term (≥180 days) REs and PEs were reviewed similarly (intermediate-term group).

RESULTS

Fifty-one cases in the short-term group had no complications on PE or RE. Forty-nine dogs were diagnosed with minor complications (patellar ligament desmitis, patella or fibula fracture, gait abnormalities): 42 on RE only; 6 on PE and RE; 1 on PE only. Exercise restriction was extended for 2 weeks in 2 cases with radiographic patellar ligament desmitis. Two cases in the intermediate-term group had minor complications at intermediate-term RE. No new PE or RE complications developed between short-term and intermediate-term evaluations.

CONCLUSION

At routine rechecks of dogs with no owner-perceived issues after TPLO, 49% had minor complications but only 2% were deemed significant enough to alter patient management. The likelihood of new radiographic complications developing after short-term evaluation is low.

CLINICAL SIGNIFICANCE

Routine radiographic recheck examinations rarely altered the postoperative plan in TPLO cases with unremarkable clinical recoveries.

In vitro elution of amikacin and Dispersin B from a polymer hydrogel

OBJECTIVE

To characterize the in vitro elution of amikacin and Dispersin B (β-N-acetylglucosaminidase) in a degradable hydrogel.

STUDY DESIGN

In vitro, prospective study.

METHODS

Amikacin (group A; 40 mg/mL), Dispersin B (group D; 70 μg/mL), or combined amikacin and Dispersin B (group AD; 40 mg/mL and 70 μg/mL, respectively) were added to a hydrogel. Ten aliquots per group were incubated in phosphate-buffered saline that was exchanged at 1, 4, 8, 12, and 24 hours and then once daily for 10 days. Eluted amikacin and Dispersin B were quantitated by using an amikacin reagent kit and a Dispersin B enzyme-linked immunosorbent assay kit, respectively. Time point drug concentrations were compared between groups by using repeated-measures analysis of variance, and total drug elution was compared by using an area under the curve calculation.

RESULTS

Amikacin alone, Dispersin B alone, and amikacin and Dispersin B combined together underwent rapid elution in the first 24 hours, followed by a gradual decrease over 10 days. The concentration of Dispersin B eluted in group D was higher at 1 day and lower from day 5 to day 10 compared with that in group AD. The concentration of amikacin eluted in group A was higher at 1, 4, and 8 hours and on day 10 and lower on day 1 compared with that in group AD. The total elution of amikacin was greater from group AD compared with that from group A (P = .02).

CONCLUSION

Combining amikacin and Dispersin B had an affect on the total elution of amikacin but not Dispersin B.

CLINICAL SIGNIFICANCE

The combination of amikacin and Dispersin B in a degradable hydrogel could allow local treatment of complex infections without the requirement for multiple invasive procedures.