Antibacterial surface modification of titanium implants in orthopaedics

Abstract

The use of biomaterials in orthopaedics for joint replacement, fracture healing and bone regeneration is a rapidly expanding field. Infection of these biomaterials is a major healthcare burden, leading to significant morbidity and mortality. Furthermore, the cost to healthcare systems is increasing dramatically. With advances in implant design and production, research has predominately focussed on osseointegration; however, modification of implant material, surface topography and chemistry can also provide antibacterial activity. With the increasing burden of infection, it is vitally important that we consider the bacterial interaction with the biomaterial and the host when designing and manufacturing future implants. During this review, we will elucidate the interaction between patient, biomaterial surface and bacteria. We aim to review current and developing surface modifications with a view towards antibacterial orthopaedic implants for clinical applications.

Encapsulated bacteriophages in alginate-nanohydroxyapatite hydrogel as a novel delivery system to prevent orthopedic implant-associated infections

“…Any surgical intervention, particularly including biomaterials implantation, is associated to high risk of infection, which can be devastating for the patients, generating overload healthcare systems. 29 Antimicrobial-loaded biomaterials, as delivery systems, have received special attention in applications for prevention and treatment of implant-related infections. 9,29 However, limited antimicrobial diffusion, sub-therapeutic levels of antimicrobial agent, dose-dependent antimicrobial activity, antimicrobials' toxicity, and the spread of antibiotic-resistant bacteria, underscore the need for new approaches to control these bacterial infections.…”

“…29 Antimicrobial-loaded biomaterials, as delivery systems, have received special attention in applications for prevention and treatment of implant-related infections. 9,29 However, limited antimicrobial diffusion, sub-therapeutic levels of antimicrobial agent, dose-dependent antimicrobial activity, antimicrobials' toxicity, and the spread of antibiotic-resistant bacteria, underscore the need for new approaches to control these bacterial infections. 6,7,9,30 In this study, a new drug-delivery system based on encapsulated phages on Alg-nanoHA hydrogels was assessed as a multifunctional approach.…”

Role of implants surface modification in osseointegration: A systematic review

“…It is inevitable that the insertion of prosthesis into bone tissue will cause the immune reaction. Various orthopedic implants with antibacterial surfaces that are already used, for example, coating with silver, showed better OI potential as well (Orapiriyakul, Young, Damiati, & Tsimbouri, 2018). Macrophages, a type of mononuclear phagocyte, are the precursors of osteoclasts that have increased much interest in the field of osteoimmunology.…”

“…What's more, they contribute to the genesis of osteoblasts and provide the trophic support for bone anabolism (Batoon, Millard, Raggatt, & Pettit, 2017). Various orthopedic implants with antibacterial surfaces that are already used, for example, coating with silver, showed better OI potential as well (Orapiriyakul, Young, Damiati, & Tsimbouri, 2018). However, it is to remind that the OI process may differ from animals and human so that it must be carefully considered when applying for the clinical practice (Abrahamsson, Berglundh, Linder, Lang, & Lindhe, 2004;Bosshardt et al, 2011).…”

Role of the Complement System in the Response to Orthopedic Biomaterials

“…In conclusion, biomaterial surfaces should be designed so that they limit both the response of complements to the surface itself, and pathogen-induced complement activation. Notably, orthopedic implants with various bactericidal and anti-adhesive surfaces are currently being developed or are already in clinical use, and modulation strategies include, for example, nanotopographical changes and surface-coating with ions, silver, or polymers [ 38 ].…”