Antibiotic-loaded amphora-shaped pores on a titanium implant surface enhance osteointegration and prevent infections

Abstract

Artificial prostheses for joint replacement are indispensable in orthopedic surgery. Unfortunately, the implanted surface is attractive to not only host cells but also bacteria. To enable better osteointegration, a mechanically stable porous structure was created on a titanium surface using laser treatment and metallic silver particles were embedded in a hydrophilic titanium oxide layer on top. The laser structuring resulted in unique amphora-shaped pores. Due to their hydrophilic surface conditions and capillary forces, the pores can be loaded preoperative with the antibiotic of choice/need, such as gentamicin. Cytotoxicity and differentiation assays with primary human osteoblast-like cells revealed no negative effect of the surface modification with or without gentamicin loading. An in vivo biocompatibility study showed significantly enhanced osteointegration as measured by push-out testing and histomorphometry 56 days after the implantation of the K-wires into rat femora. Using a S. aureus infection model, the porous, silver-coated K-wires slightly reduced the signs of bone destruction, while the wires were still colonized after 28 days. Loading the amphora-shaped pores with gentamicin significantly reduced the histopathological signs of bone destruction and no bacteria were detected on the wires. Taken together, this novel surface modification can be applied to new or established orthopedic implants. It enables preoperative loading with the antibiotic of choice/need without further equipment or post-coating, and supports osteointegration without a negative effect of the released dug, such as gentamicin.

Infections @ Trauma/Orthopedic Implants: Recent Advances on Materials, Methods, and Microbes—A Mini-Review

“…Based on a just recently characterized surface modification, the surface stability, effect on cells and bacteria, as well as osteointegration and antibacterial effectivity in vivo was evaluated [ 27 ]. Amphora-shaped pores of the Ti were coated with Ag and loaded with gentamicin.…”

Biofilms in Surgical Site Infections: Recent Advances and Novel Prevention and Eradication Strategies

“…Some of these strategies that are being presently adopted to treat SSIs associated with biofilm formation are: inhibiting the attachment of the microorganisms to the substratum, using special compounds that interfere with and unsettle the biofilm structure, and disrupting the biofilm at the initial stages [ 22 , 23 ]. For example, to help control the rate of SSIs, new antiadhesive surfaces with altered physical, chemical, and topographical properties that prevent microbial adhesion and thereby biofilm formation have been tested on several medical devices [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

“…Several antimicrobial compounds have been identified as potential biofilm eradicators, namely antimicrobial peptides (AMPs), EPS-targeting enzymes, antimicrobial lipids, quaternary ammonium compounds (QACs), nitric-oxide-releasing antibiotics, and others [ 8 ]. Nanotechnology-based approaches, predominantly different types of NPs, metal organic frameworks (MOFs), and other nanomaterials, are also amongst the most studied line of attack to deal with pathogenic biofilms [ 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ]. Natural plant-based products are being developed to help overcome the problem with multidrug-resistant bacteria, namely plant extracts and isolated compounds, as well as essential oils that contain large amounts of phytochemicals [ 33 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ].…”

Trends in Managing Cardiac and Orthopaedic Device-Associated Infections by Using Therapeutic Biomaterials

“…Gentamicin-based coatings are the most studied owing to the well-established use of this antibiotic in the clinic for MSSA bone-related infections treatments [ 86 , 87 , 88 , 89 , 90 ]. Vancomycin, commonly used to treat MRSA infections, has also been incorporated into implant coatings.…”