DAC® HYDROGEL – FREQUENTLY ASKED QUESTIONS

Q1: What is DAC® Hydrogel Coating?
A: DAC® (Defensive Antibacterial Coating) is a CE-marked, fast-resorbable hydrogel
composed of hyaluronic acid and polylactic acid. It is applied directly to orthopaedic and
trauma implants at the time of surgery, forming a temporary physical barrier to prevent
bacterial adhesion and biofilm formation, while permitting normal bone healing and
osseointegration.

Q2: How long has DAC® been in clinical use?
A: DAC® has been commercially available for over 10 years, with no modifications since
its launch. During this time a wealth of clinical experience has been gained see Q11 below.

Q3: How is DAC® supplied and prepared?
A: DAC® is supplied as a sterile powder, which is mixed in the operating theatre with
sterile water to create a hydrogel. Preparation typically takes 3 to 5 minutes. Once mixed,
you can leave the two syringes connected until the hydrogel is needed. Mixing should take
place 10 to 15 minutes before use, therefore it is recommended to mix at the start of the
procedure.

Q4: How far in advance can DAC® be prepared before surgery?
A: The hydrogel can be hydrated and prepared up to 4 hours prior to application.

Q5: How much DAC® is needed for a procedure?
A: A 5ml syringe is generally sufficient to coat a primary cementless hip or knee
arthroplasty implant. Larger implants or complex revision cases may require a 10ml size.

Q6: Does DAC® require refrigeration?
A: Yes — unopened DAC® should be stored between 2°C and 8°C. Once mixed, it can
remain at room temperature in the sterile field in theatres until required.

Q7: Is there a technique video available?
A: Yes — DAC® mixing and application videos are available at: https://www.daccoating.com/dac/video/

Q8: What training resources are provided?
A: Adler Ortho UK offers face-to-face theatre training, DAC® instructions supplied in every
box, theatre wall posters, mixing videos, surgical technique brochures and on-site clinical
support.

Q9: Is DAC® as pharmaceutical product?
A: No — DAC® is licensed as a medical device and is not supplied in combination with
any other products. DAC® is licensed as a physical barrier coating without antibiotics and
is intended for the prevention of infection.

Q10: Are there any clinical studies on DAC® being used with antibiotics and what
safety and efficacy effect would this have on the product?
A: Yes — There have been a large number of independent studies *1,2,3, where antibiotics
have been used in conjunction with DAC® Hydrogel to ensure its safety and efficacy.
Since Antibiotics are not supplied with DAC® the choice and use is at the surgeons
discretion, appropriate to the patient. Allergies to antibiotics must be considered if they are
to be used as well as the overall level of antibiotics the patient is receiving. In general
studies conducted have used a concentration of 2% to 5%.

Q11. What do the results of DAC® without antibiotics show in the short medium and
long term?
A: We have conducted a retrospective, matched case-control study evaluating DAC® gel,
a hyaluronan-based barrier, in reducing post-operative infections following fracture fixation.
Patients:
DAC® group: 150 patients (May 2023 – April 2024)
Control group: 150 patients (Jan 2021 – Aug 2022)
Intervention:
DAC® gel was applied to implant surfaces (plates, screws, nails) without added
antibiotics, alongside standard surgical care and systemic prophylaxis.
Follow-up: 1–3 weeks, 3 months, and 6 months post-op
6-Month Outcomes:
Control group: 8 infections (of which 2.2% required DAIR, 9% needed prolonged
antibiotics (p = 0.0023 vs DAC®)
DAC® group: 1 infection
These early results suggest DAC® may reduce infection rates in at-risk fracture patients.
Full findings awaiting publication.*4

Q12: What clinical evidence supports DAC®?
A: DAC® is supported by over 50 published studies, papers, abstracts and presentations
over a 10 year period, including two multi-centre randomised controlled trials M-RCT :
– Fast-resorbable antibiotic-loaded hydrogel coating to reduce post-surgical
infection after internal osteosynthesis: a multi-centre randomised controlled trial. J
Orthop Traumatol. 2017 Jun;18(2):159-169 *5
– Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical
Infection After Joint Arthroplasty? J Bone Jt Infect. 2016 Jul 19:1:34-41.*6

Q13: What infection reduction rates have been reported?
A: Clinical studies report a reduction in infection rates in high-risk revision cases, with
significant reductions also seen in primary arthroplasty procedures.

Q14: Is there evidence of DAC® remaining on implants after press-fit insertion?
A: Yes — Animal and Human femur studies confirm that around 80% of DAC® hydrogel
remains on the implant surface following press-fit insertion, with the remainder adhering to
surrounding bone.

Q15: Does DAC® affect osseointegration or implant fixation?
A: No — DAC® fully resorbs within 72 hours and has demonstrated no adverse effects on
bone healing or cemented fixation in both preclinical and clinical studies.

Q16: Can DAC® be applied to cemented implants?
A: It can be applied to surfaces not covered by bone cement, such as press-fit extensions
or non-cemented modular components in hybrid procedures.

Q17: Are there any adverse effects reported?
A: Adverse reactions are rare since DAC® is manufactured from
– Hyaluronic acid (HA) is a naturally occurring substance found in the human body.
Highly biocompatible, surfaces coated with HA show minimal bacterial biofilm growth,
making it renowned for its exceptional moisture retention capabilities.
– Poly-lactic acid (PLA) is a safe, biodegradable and bio-absorbable synthetic
polymer obtained from renewable sources (corn or other cereals). It is commonly used in
various applications, including medical devices. PLA decomposes into harmless
byproducts in the environment, contributing to its eco-friendliness.

Q18: Is there a contraindication if DAC® contacts soft tissue?
A: No adverse effects have been reported when DAC® comes into contact with
surrounding soft tissues.

Q19: Is DAC® available on NHS Supply Chain frameworks?
A: DAC® is currently available through the All Wales and Scottish National Frameworks
and a submission has also been made to the NHS TOS3 framework. As DAC® is a
unique product, the framework team is currently reviewing its classification to determine
the most appropriate category.
In the meantime, many NHS hospitals procure DAC® directly via local purchasing
routes. If you require further information on local procurement options or processes,
please contact your local DAC® representative, who will be happy to assist.

Q20: Which UK hospitals use DAC®?
A: A large number of high-volume oncology, revision and trauma centres have all used
DAC® routinely for several years. Reference presentations have been made at Welsh
Orthopaedic Society 2024, BAJIS 2024, and BHS 2025 for example.

Q21: What does DAC® cost?
A: Prices for this unique Hydrogel are available from your local Adler Ortho representative.

Q22: Is DAC® NICE approved?
A: A submission has been made for a NICE technology appraisal. Review timelines are
ongoing. The volumes of clinical papers are available on the website.

Q23: How does DAC® compare to other infection-prevention products?
A: DAC® is the only CE-marked, fast-resorbable hydrogel with over a decade of clinical
evidence across orthopaedic procedures. Unlike newer or unproven products, DAC® has
established efficacy and no reported product-related adverse events.

Q24: What are the economic benefits?
A: A healthcare economic study by Trentinaglia et al. demonstrated that antibacterial
coatings like DAC® reduce healthcare costs by preventing infections, particularly in highrisk
patients. A UK multi-centre study (Garfield et al., 2020) found that prosthetic joint
infections following primary hip replacement increase NHS inpatient costs by over £33,000
— rising significantly higher in revision cases.

Q25: Where can I find out more clinical evidence ?
A: A comprehensive list of all clinical papers on DAC can be found on the website
www.dac-coating.com