Implant retention in a sheep fracture related infection model


Management of fracture related infection (FRI) often involves further surgical procedures with poor long-term outcomes. Debridement, Antibiotics, Irrigation and implant Retention (DAIR) is a surgical treatment protocol often applied to acute/early FRI. Clinically relevant pre-clinical models of DAIR in FRI are scarce and none have been developed in large animals. 




Develop a large animal model for FRI including a DAIR approach. Moreover, to increase the treatment success of DAIR in FRI, a new ARI-developed hydrogel containing antibiotics will be applied during revision surgery. Additionally, the fracture healing over time will be monitored using the ARI fracture monitor sensor.



The first outcomes prove that it is possible to establish a model of FRI with plating osteosynthesis. Analyses of the samples show high bacterial burden at revision and still traces of infection at euthanasia. Using the fracture monitor it will be possible to correlate fracture healing with infection status. Next, application of the antibiotic-loaded hydrogel will be performed. The overall project, through development of a new animal model and treatment modalities may allow us to expand the number of patients receiving DAIR and thereby reducing patient burden.

  • Publication
    Moriarty TF, Muthukrishnan G, Daiss JL, Xie C, Nishitani K, Morita Y, Awad H, de Mesy Bentley KL, Masters E, Bui T, Yan M, Owen J, Mooney B, Gill S, Puetzler J, Wenke JC, Morgenstern M, Metsemakers WJ, Noll C, Joeris A, Richards RG, Schwarz EM, Kates SL. Bone infection: a clinical priority for clinicians, scientists and educators. Eur Cell Mater. 2021;42:312-33.

    Siverino C, Nylund P, Foster AL, Boot W, Zeiter S, Richards RG, D'Este M, Moriarty TF. Gentamycin-vancomycin loaded emulsion-based hydrogel to treat methicillin resistant S. aureus-orthopedic device-related infection in a single stage revision. 2023 ESB (Biomaterials) / (poster)

  • Presentation
    Siverino C, Gens L, Ernst M, Buchholz T, Windolf M, Zeiter S, Richards RG, Moriarty TF. Debridement, antibiotics, irrigation, and implant retention in a sheep fracture-related infection model. 2023 ORS (oral)