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

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 9 10 2 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 nanoparticles and their orthopaedic applications

“…There was no statistically significant difference in bacterial adhesion when comparing the control groups with the silver-coated implants. More recent in vivo work by Kose et al 61 used a more sophisticated method of silver coating. In their study, instead of directly coating the implants with metallic silver, a silver ion-doped calcium phosphate-based ceramic nanopowder was developed, the idea being that ionic silver is more biologically active.…”

“…In the silver-coated group, the antimicrobial outcomes were more favourable, with a lower proportion of positive cultures and lower rates of osteomyelitis. 61 Comparing the results of these two studies, it may be hypothesised that advances in the production of silver coatings have allowed for the manufacture of more biologically active models.…”

Cytotoxicity of a new antimicrobial coating for surgical screws: an in vivo study

“…(4,18) Such materials include silver and silver compounds, selenium and antimicrobial peptides. (5,(17)(18)(19)(20) Silver-or selenium-coated implants are effective (20,21) but expensive; furthermore, the use …”

Current and future applications of nanotechnology in plastic and reconstructive surgery

“…Kose et al [36] examined silica-based mesoporous materials to characterize the features that determine the loading capacity and delivery of medications integrated into these devices. They specifically focused on silica-based mesoporous materials because they can be manufactured with a high degree of homogeneity with a tunable pore size.…”