The Journal of Bone and Joint Surgery, Vol 67, Issue 8 1236-1244, Copyright © 1985 by Journal of Bone and Joint Surgery, Inc
The influence of skeletal implants on incidence of infection. Experiments in a canine model
W Petty, S Spanier, JJ Shuster and C Silverthorne
We have performed experiments in 187 dogs in order to evaluate the effect
of commonly used implant materials on rate of infection. We opened the
femoral canal with a hand drill and awl, instilled a suspension of
bacteria, and then inserted one of the implants. The
implants--stainless-steel and cobalt-chromium alloys, high-density
polyethylene, prepolymerized polymethylmethacrylate, and
polymethylmethacrylate polymerized in vivo--were compared with no implant
(control). The effect of the different implants on the incidence of
infection with Staphylococcus epidermidis, Staphylococcus aureus, and
Escherichia coli was compared by determining the number of bacteria
required to produce infection in 50 per cent of the femora. All of the
implants were significantly more likely than the controls to be associated
with infection with Staphylococcus aureus. Polymethylmethacrylate
polymerized in vivo was found to be significantly more likely than all
other implants to be associated with infection with Escherichia coli and
Staphylococcus epidermidis. In addition to evaluating all specimens
bacteriologically, we carried out a histological evaluation, and found that
infection was highly correlated with an increased inflammatory response for
all three bacteria. However, even with this highly statistically
significant correlation, the correlation was not absolute; when only
limited portions of randomly selected specimens of tissue were examined,
the correlation was reduced.
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