Antibacterial Surface Treatment for Orthopaedic Implants

Abstract

It is expected that the projected increased usage of implantable devices in medicine will result in a natural rise in the number of infections related to these cases. Some patients are unable to autonomously prevent formation of biofilm on implant surfaces. Suppression of the local peri-implant immune response is an important contributory factor. Substantial avascular scar tissue encountered during revision joint replacement surgery places these cases at an especially high risk of periprosthetic joint infection. A critical pathogenic event in the process of biofilm formation is bacterial adhesion. Prevention of biomaterial-associated infections should be concurrently focused on at least two targets: inhibition of biofilm formation and minimizing local immune response suppression. Current knowledge of antimicrobial surface treatments suitable for prevention of prosthetic joint infection is reviewed. Several surface treatment modalities have been proposed. Minimizing bacterial adhesion, biofilm formation inhibition, and bactericidal approaches are discussed. The ultimate anti-infective surface should be “smart” and responsive to even the lowest bacterial load. While research in this field is promising, there appears to be a great discrepancy between proposed and clinically implemented strategies, and there is urgent need for translational science focusing on this topic.

Antimicrobial technology in orthopedic and spinal implants

“…Note the permeation through the porous wall (arrows) [64] ; B: Scheme of implanted fixation pins, each capable of eluting local antibiotics around fixation site [65] . Figure 7 Interaction between surface roughness and bacterial adhesion [69] . Micrograph and apparatus perspective of electrospinning technology.…”

“…For example, mixtures of polyethylene oxide and proteinrepelling polyethylene glycol have shown significant bacterial inhibition when applied implant surfaces [66,67] . Singh et al [68] demonstrated that modifying surface roughness (Figures 7 [69] and 8) of a material at the nanoscale level could provide antibacterial properties. Surface characteristic modification has been shown to interfere with osseointegration of the implants, challenging its clinical application [70] .…”

Antibacterial PHAs coating for titanium implants

“…H 1 NMR was carried out to verify the biopolymers structure ( figure 2 A and B). The characteristic peaks at 0.99 ppm and 1.25 ppm for methyl group for valerate and hydroxybutyrate monomers, respectively, can be used to determine the valeric composition in the copolymer PHBV sample according to equation 1 [27,28]: [1] It was confirmed that PHBV has 19 mol% of the monomer HV. The presence of this monomer decreases the polymer crystallinity and, thus, its mechanical properties change (high elastic modulus and flexural strength with low tensile strength and elongation at break) [29] and degradability [30].…”

“…The removal of an infected implant is the final outcome of most of these infections, generating high costs for the health-care system and discomfort for the patient. Biomaterial infections are developed on the implant surface due to the ability of microorganisms to get attached and to further form biofilms [1]. Therefore, the study and the improvement of the implant surface to avoid the first stage for the biofilm formation of the pathogenic microorganism is required.…”

Nanomedicine applications in orthopedic medicine: state of the art

“…87 These natural materials have the advantage over synthetic ones in being similar to materials in the body and have potential to be used as implant surface scaffolds. 88, 89 Levengood and Zhang 15 highlighted recent advances in the development of CS-based scaffolds with enhanced bone regeneration capability. Mandal et al 90 fabricated silk-fiber-reinforced composite matrices with a high compressive strength (∼13 MPa hydrated state) for bone engineering applications.…”