Top

Clinical Orthopaedics and Related Research®

Published in:

01-08-2013 | Symposium: Nanoscience in Musculoskeletal Medicine

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Authors: Nusret Kose, MD, Ali Otuzbir, MD, Ceren Pekşen, PhD, Abdurrahman Kiremitçi, MD, Aydın Doğan, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 8/2013

Abstract

Background

Despite progress in surgical techniques, 1% to 2% of joint arthroplasties become complicated by infection. Coating implant surfaces with antimicrobial agents have been attempted to prevent initial bacterial adhesion to implants with varying success rates. We developed a silver ion-containing calcium phosphate-based ceramic nanopowder coating to provide antibacterial activity for orthopaedic implants.

Questions/purposes

We asked whether titanium prostheses coated with this nanopowder would show resistance to bacterial colonization as compared with uncoated prostheses.

Methods

We inserted titanium implants (uncoated [n = 9], hydroxyapatite-coated [n = 9], silver-coated [n = 9]) simulating knee prostheses into 27 rabbits’ knees. Before implantation, 5 × 10² colony-forming units of Staphylococcus aureus were inoculated into the femoral canal. Radiology, microbiology, and histology findings were quantified at Week 6 to define the infection, microbiologically by increased rate of implant colonization/positive cultures, histologically by leukocyte infiltration, necrosis, foreign-body granuloma, and devitalized bone, and radiographically by periosteal reaction, osteolysis, or sequestrum formation.

Results

Swab samples taken from medullary canals and implants revealed a lower proportion of positive culture in silver-coated implants (one of nine) than in uncoated (eight of nine) or hydroxyapatite-coated (five of nine) implants. Silver-coated implants also had a lower rate of colonization. No cellular inflammation or foreign-body granuloma was observed around the silver-coated prostheses.

Conclusions

Silver ion-doped ceramic nanopowder coating of titanium implants led to an increase in resistance to bacterial colonization compared to uncoated implants.

Clinical Relevance

Silver-coated orthopaedic implants may be useful for resistance to local infection but will require in vivo confirmation.

Aktekin CN, Ozturk AM, Tabak AY, Altay M, Korkusuz F. A different perspective for radiological evaluation of experimental osteomyelitis. Skeletal Radiol. 2007;36:945–950.PubMedCrossRef

Alt V, Bitschnau A, Osterling J, Sewing A, Meyer C, Kraus R, Meissner SA, Wenisch S, Domann E, Schnettler R. The effects of combined gentamicin-hydroxyapatite coating for cementless joint prostheses on the reduction of infection rates in a rabbit infection prophylaxis model. Biomaterials. 2006;27:4627–4634.PubMedCrossRef

Bai X, More K, Rouleau CM, Rabiei A. Functionally graded hydroxyapatite coatings doped with antibacterial components. Acta Biomater. 2010;6:2264–2273.PubMedCrossRef

Bosetti M, Masse A, Tobin E, Cannas M. Silver coated materials for external fixation devices: in vitro biocompatibility and genotoxicity. Biomaterials. 2002;23:887–892.PubMedCrossRef

Chen W, Liu Y, Courtney HS, Bettenga M, Agrawal CM, Bumgardner JD, Ong JL. In vitro antibacterial and biological properties of magnetron co-sputtered silver-containing hydroxyapatite coating. Biomaterials. 2006;27:5512–5517.PubMedCrossRef

Chen W, Oh S, Ong AP, Oh N, Liu Y, Courtney HS, Appleford M, Ong JL. Antibacterial and osteogenic properties hydroxyapatite coatings produced using of silver-containing a sol gel process. J Biomed Mater Res A. 2007;82:899–906.PubMed

Chen Y, Zheng X, Xie Y, Ding C, Ruan H, Fan C. Anti-bacterial and cytotoxic properties of plasma sprayed silver-containing HA coatings. J Mater Sci Mater Med. 2008;19:3603–3609.PubMedCrossRef

Collinet-Adler S, Castro CA, Ledonio CG, Bechtold JE, Tsukayama DT. Acinetobacter baumannii is not associated with osteomyelitis in a rat model: a pilot study. Clin Orthop Relat Res. 2011;469:274–282.PubMedCrossRef

Darouiche RO. Anti-infective efficacy of silver-coated medical prostheses. Clin Infect Dis. 1999;29:1371–1377.PubMedCrossRef

10.

Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.PubMedCrossRef

11.

Darouiche RO, Mansouri MD, Zakarevicz D, Alsharif A, Landon GC. In vivo efficacy of antimicrobial-coated devices. J Bone Joint Surg Am. 2007;89:792–797.PubMedCrossRef

12.

Darouiche RO, Raad II, Bodey GP, Musher DM. Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia: potential role of the combination of minocycline and rifampin. Int J Antimicrob Agents. 1995;6:31–36.PubMedCrossRef

13.

Garvin KL, Hanssen AD. Current concepts review: infection after total hip arthroplasty. J Bone Joint Surg Am. 1995;77:1576–1588.PubMed

14.

Gosheger G, Hardes J, Ahrens H, Streitburger A, Buerger H, Erren M, Gunsel A, Kemper FH, Winkelmann W, Von Eiff C. Silver-coated megaendoprostheses in a rabbit model—an analysis of the infection rate and toxicological side effects. Biomaterials. 2004;25:5547–5556.PubMedCrossRef

15.

Gristina G, Costerton JW. Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am. 1984;15:517–535.PubMed

16.

Grunlan JC, Choi JK, Lin A. Antimicrobial behavior of polyelectrolyte multilayer films containing cetrimide and silver. Biomacromolecules. 2005;6:1149–1153.PubMedCrossRef

17.

Hardes J, Ahrens H, Gebert C, Streitbuerger A, Buerger H, Erren M, Gunsel A, Wedemeyer C, Saxler G, Winkelmann W, Gosheger G. Lack of toxicological side-effects in silver coated megaprostheses in humans. Biomaterials. 2007;28:2869–2875.PubMedCrossRef

18.

Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ. Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection. Biomaterials. 2004;25:545–556.PubMedCrossRef

19.

Isiklar ZU, Darouiche RO, Landon GC, Beck T. Efficacy of antibiotics alone for orthopaedic device related infections. Clin Orthop Relat Res. 1996;332:184–189.PubMedCrossRef

20.

Jung WK, Koo HC, Kim KW, Shin S, Kim SH, Park YH. Antibacterial activity and mechanism of action of the silver ion in Staphylococcus aureus and Escherichia coli. Appl Environ Microbiol. 2008;74:2171–2178.PubMedCrossRef

21.

Leeuwenburgh S, Wolke J, Schoonman J, Jansen JA. Influence of deposition parameters on chemical properties of calcium phosphate coatings prepared by using electrostatic spray deposition. J Biomed Mater Res A. 2005;74:275–284.PubMed

22.

Nasser S. Prevention and treatment of sepsis in total hip replacement surgery. Orthop Clin North Am. 1992;23:265–277.PubMed

23.

Noda I, Miyaji F, Ando Y, Miyamoto H, Shimazaki T, Yonekura Y, Miyazaki M, Mawatari M, Hotokebuchi T. Development of novel thermal sprayed antibacterial coating and evaluation of release properties of silver ions. J Biomed Mater Res B Appl Biomater. 2009;89:456–465.PubMed

24.

Peterson JJ. Postoperative infection. Radiol Clin North Am. 2006;44:439–450.PubMedCrossRef

25.

Petty W, Spanier S, Shuster JJ, Silverthorne C. The influence of skeletal implants on incidence of infection: experiment in a canine model. J Bone Joint Surg Am. 1985;67;1236–1244.PubMed

26.

Sculco TP. The economic impact of infected joint arthroplasty. Orthopedics. 1995;18:871–873.PubMed

27.

Song WH, Ryu HS, Hong SH. Antibacterial properties of Ag (or Pt)-containing calcium phosphate coating formed by micro-arc oxidation. J Biomed Mater Res A. 2009;88:246–254.PubMed

28.

Taniguchi I, Schoonman J. Electrostatic spray deposition of perovskite-type oxide thin films with porous microstructure. J Mater Synth Process. 2002;10:267–275.CrossRef

29.

Thian ES, Li X, Huang J, Edirisinghe MJ, Bonfield W, Best SM. Electrospray deposition of nanohydroxyapatite coatings: a strategy to mimic bone apatite mineral. Thin Solid Films. 2011;519:2328–2331.CrossRef

30.

Vik H, Andersen KJ, Julshamn K, Todnem K. Neuropathy caused by silver absorption from arthroplasty cement. Lancet. 1985;1:872.PubMedCrossRef

31.

Vogely HC, Oosterbos CJ, Puts EW, Nijhof MW, Nikkels PG, Fleer A, Tonino AJ, Dhert WJ, Verbout AJ. Effects of hydroxyapatite coating on Ti-6A1-4V implant-site infection in a rabbit tibial model. J Orthop Res. 2000;18:485–493.PubMedCrossRef

Title: A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance
Authors: Nusret Kose, MD
Ali Otuzbir, MD
Ceren Pekşen, PhD
Abdurrahman Kiremitçi, MD
Aydın Doğan, PhD
Publication date: 01-08-2013
Publisher: Springer US
Published in: Clinical Orthopaedics and Related Research® / Issue 8/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-013-2894-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Clinical Relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Clinical Relevance

Please log in to get access to this content

Other articles of this Issue 8/2013

Swiss Contributions to War Surgery During the Great War

pHEMA-nHA Encapsulation and Delivery of Vancomycin and rhBMP-2 Enhances its Role as a Bone Graft Substitute

Why Do Hip Arthroscopy Procedures Fail?

Spontaneous Hip Labrum Regrowth After Initial Surgical Débridement

Giants of Orthopaedic Surgery: Masaki Watanabe MD

Surgical Technique: Endoscopic Gluteus Maximus Tendon Release for External Snapping Hip Syndrome