Hyaluronic-Based Antibacterial Hydrogel Coating for Implantable Biomaterials in Orthopedics and Trauma: From Basic Research to Clinical Applications

Abstract

Bacterial colonization of implanted biomaterials remains one of the most challenging complications in orthopedics and trauma surgery, with extremely high social and economic costs. Antibacterial coating of implants has been advocated by many experts as a possible solution to reduce the burden of implant-related infection and several different solutions have been proposed in the last decades. However, while most of the investigated technologies have shown their efficacy in vitro and/or in vivo, only few were able to reach the market, due to clinical, industrial, economic and regulatory issues. Hyaluronic acid composites have been previously shown to possess antifouling capabilities and have been used in various clinical settings to reduce bacterial adhesion and mitigate biofilm-related infections. Recently, a fast-resorbable, hyaluronic-based hydrogel coating was developed to protect implanted biomaterials in orthopedics, trauma and maxillofacial surgery. Preclinical and clinical testing did show the safety and efficacy of the device that can be intraoperatively loaded with one or more antibiotics and directly applied by the surgeon to the implant surface, at the time of surgery. Here, we review the current evidence concerning this very first antibacterial coating of implants and outline the economic impact of the possible large-scale application of this technology.

Conformal Electrodeposition of Antimicrobial Hydrogels Formed by Self‐Assembled Peptide Amphiphiles

“…[9] The use of antimicrobial hydrogel coatings is an interesting strategy to prevent the colonization of medical material. [10][11][12] For example, the manual application (i.e., using a brush) of an antimicrobial polymer-based hydrogel containing gentamycin and vancomycin reduced by 86% the bacterial colonization of titanium substrates. [12] However, manual application onto complex-shaped devices, such as screws or stents, can be difficult and ineffective.…”

Hyaluronic Acid-Based Nanomaterials as a New Approach to the Treatment and Prevention of Bacterial Infections

“…Given the rapid hydrolysis of HA by natural hyaluronidase enzymes, the use of pure HA would not be appropriate as an antimicrobial coating. Because of its strong hydrophilicity, a HA-based hydrogel used alone would also not be a suitable coating with sufficient mechanical stability in a water-based environment such as the human body ( Gaetano et al, 2018 ). Therefore, to overcome these drawbacks and increase the biological half-life of HA, chemically crosslinked HA nanogels were created because they are often more stable than the physically crosslinked analogs.…”

WPI Hydrogels with a Prolonged Drug-Release Profile for Antimicrobial Therapy

“…A hydrogel coating based on hyaluronic acid and poly-D,L-lactide has recently been developed [DAC ® (Defensive Antibacterial Coating), Novagenit Srl, Mezzolombardo, Italy]. This hydrogel is expected to be useful as an antibacterial coating for implantable devices that provides a protective barrier against bacterial adhesion [19][20][21][22]. Clinical trials have demonstrated its ability to reduce postoperative infectious sequelae associated with implants [23,24].…”