Chitosan and Hydroxyapatite Based Biomaterials to Circumvent Periprosthetic Joint Infections

Abstract

Every year, worldwide, millions of people suffering from joint pain undergo joint replacement. For most patients, joint arthroplasty reduces pain and improve function, though a small fraction will experience implant failure. One of the main reasons includes prosthetic joint infection (PJI), involving the prosthesis and adjacent tissues. Few microorganisms (MO) are required to inoculate the implant, resulting in the formation of a biofilm on its surface. Standard treatment includes not only removal of the infected prosthesis but also the elimination of necrotic bone fragments, local and/or systemic administration of antibiotics, and revision arthroplasty with a new prosthesis, immediately after the infection is cleared. Therefore, an alternative to the conventional therapeutics would be the incorporation of natural antimicrobial compounds into the prosthesis. Chitosan (Ch) is a potential valuable biomaterial presenting properties such as biocompatibility, biodegradability, low immunogenicity, wound healing ability, antimicrobial activity, and anti-inflammatory potential. Regarding its antimicrobial activity, Gram-negative and Gram-positive bacteria, as well as fungi are highly susceptible to chitosan. Calcium phosphate (CaP)-based materials are commonly utilized in orthopedic and dentistry for their excellent biocompatibility and bioactivity, particularly in the establishment of cohesive bone bonding that yields effective and rapid osteointegration. At present, the majority of CaP-based materials are synthetic, which conducts to the depletion of the natural resources of phosphorous in the future due to the extensive use of phosphate. CaP in the form of hydroxyapatite (HAp) may be extracted from natural sources as fish bones or scales, which are by-products of the fish food industry. Thus, this review aims to enlighten the fundamental characteristics of Ch and HAp biomaterials which makes them attractive to PJI prevention and bone regeneration, summarizing relevant studies with these biomaterials to the field.

Novel Silver-Functionalized Poly(ε-Caprolactone)/Biphasic Calcium Phosphate Scaffolds Designed to Counteract Post-Surgical Infections in Orthopedic Applications

“…In surgery, device implantation results in a non-negligible occurrence of infections, one of the major causes of morbidity and mortality in this medical field [ 3 , 31 ]. A foreign body is the triggering event for biomaterial-associated infections (BAIs) because certain features of a biomaterial, such as its surface and roughness characteristics, not only attract host eukaryotic cells involved in tissue regeneration, but also free-floating bacteria.…”

“…Orthopedic prosthetic surgery for bone repair is the most common standard cure worldwide for joint osteoarthritis, rheumatic diseases, tumor resection and some types of fractures [ 1 , 2 , 3 , 4 ]. Currently, physicians perform millions of these surgeries, but the number is expected to quadruple over the next one to two decades [ 5 , 6 , 7 ].…”

“…Frequently, the diagnosis of infection is complicated by the failure of traditional microbiological culture techniques to isolate the causative pathogen, which is due to the fact that microorganisms are organized and embedded within complex structures, namely biofilms, that typically occur on prosthetic surfaces [ 3 , 20 , 21 ]. The occurrence of biofilm results in difficulties for diagnosis and treatment: the adhesion of microorganisms to prosthetic surfaces reduces their likelihood of detection, and the microenvironment within the biofilm protects bacteria from antibiotics applied in treatment [ 1 , 6 , 7 , 17 , 21 ].…”

Dentin-Derived-Barrier Membrane in Guided Bone Regeneration: A Case Report

“…Due to the limitation of this single case report to present the possibility of a clinical application of DDB, the concerns could not be performed for treatment alternatives, which is a comparison with other evidence-based results, such as the mechanical impact of biomaterials/TCPs on cell growth, biological behavior in other conditions, and the role of local stem cells in the local environment. Taken altogether, a general interpretation of the results in the context of other evidence and variables should be provided in future research [ 33 , 34 , 35 , 36 , 37 ].…”

Clindamycin-Based 3D-Printed and Electrospun Coatings for Treatment of Implant-Related Infections

“…However, even an ideal artificial material can only be a compromise in response to mechanical strains, physicochemical degradation, aging, wear, and tear [4]. Moreover, all implanted medical devices suffer from recognised risks of device-related infections [5,6].…”