Paper of the Week: Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

Paper of the Week: Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience

ICM Philly October 13, 2020

Massimo Franceschini, N Amir Sandiford, Vincenzo Cerbone, Lucio Cappelli Toledo de Araujo, and Daniel Kendoff

Hip Int. 2020 Sep;30(1_suppl):7-11. 
DOI: 10.1177/1120700020917125. PMID: 32907424

Summary by: Santiago Restrepo BS

With the increasing number of total hip arthroplasty procedures (THA), the incidence of Periprosthetic joint infection (PJI) is expected to also grow, which will necessitate new and effective techniques to manage and treat infections [1,2].  One potential technique is the use of antibacterial coatings that are applied on to the device during the procedure in order to prevent the formation of biofilm from bacterial adhesion[3,4]. In particular, Defensive Antibacterial Coating (DAC) is one new possible treatment that can be used for uncemented THA.

Franceschini et al. presented a description of the technique and their results after applying DAC on the implants of 28 patients undergoing 2-stage revision THA. DAC is an antibacterial hydrogel coating consisting of hyaluronan and poly-D, L-lactide that is applied to the implant during the procedure with the goal of reducing bacterial adhesion and preventing biofilm formation in order to protect the implant from the numerous infective agents. The cohort included 28 patients that had elective uncemented 2-stage revision of total hip arthroplasty with confirmed chronic PJI that met MSIS criteria. Of these, only 2 cases required revision within the first 3 weeks during a mean follow-up of 24 months (20-26 months). The remaining 26 patients had no clinical or laboratory indications of infection and were, therefore, considered successfully treated for PJI. The authors acknowledged the size of the cohort was small but believed their findings suggest that DAC is a promising technique that could be expanded to additional procedure types, such as 1-stage revision THA. Overall, the authors concluded that DAC is an effective treatment option for controlling infection in uncemented 2-stage revision THA.


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  2. Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplasty Today 2017;3:137–40.
  3. Dastgheyb S, Parvizi J, Shapiro IM, Hickok NJ, Otto M. Effect of Biofilms on Recalcitrance of Staphylococcal Joint Infection to Antibiotic Treatment. J Infect Dis 2015;211:641–50.
  4. Drago L, Boot W, Dimas K, Malizos K, Hänsch GM, Stuyck J, et al. Does Implant Coating With Antibacterial-Loaded Hydrogel Reduce Bacterial Colonization and Biofilm Formation in Vitro? Clin Orthop 2014;472:3311–23.
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