Antimicrobial technology in orthopedic and spinal implants

Abstract

Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.Key words: Antimicrobial; Coated implants; Antibiotic; Antiseptic; Nano-silver; Photoactive Core tip: Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines the latest orthopedic implant antimicrobial technologies-including updates on chitosan

A Unified Interdisciplinary Approach to Design Antibacterial Coatings for Fast Silver Release

“…Firstly, Ti substrates coated with continuous Ag thin films were tested as a reference for Ag‐based antimicrobial implant coatings . The Ag content of as‐prepared Ag thin film coated samples (black line, Ti−Ag 0 h) was determined by linear sweep voltammetry from −0.1 V to +0.4 V vs Ag/AgCl in 1 M HCl, using a scan rate of 25 mV/s (Figure a).…”

Biofilm formation in total hip arthroplasty: prevention and treatment

“…Thus, the higher infection rates associated with biomaterials when compared to common surgical site infections is explained by the increased susceptibility to infection in the presence of a biomaterial 39 . In addition to the impaired HID, certain biomaterials and/or superficial coatings can physically, chemically and biologically support and enhance microbial growth [40][41][42][43][44] . Coatings and biomaterial surfaces often incorporate superficial pores in order to encourage ingrowth of host tissue into the implant thus mediating successful integration 45,46 .…”

“…Unfortunately, these pores constitute superficial niches that physically protect microbes from phagocytic cells. Bio-resorbable biomaterials can locally dissipate nutrients over time that may be used by bacteria to support their own growth and proliferation [40][41][42][43] . Moreover, metallic ions released from certain metals, comprised within biomaterials and coatings, have been shown to chemically enhance microbial function by altering internal metabolic processes for several microbial species 44 .…”

Infection risk analysis of 101 silver-coated endoprostheses

“…4 Manufacturers have been trying to reduce endoprosthetic infection rates with antimicrobial implant surfaces like antibiotic-based, antiseptic, photoactive-based or silver coatings. [6][7][8] Antibiotic coatings have limited duration of drug elution and the risk of resistance, 9 while effective antiseptic coatings (chlorhexidine, chloroxylenol) also exhibit toxicity. 2,10 The nanostructured topography of the implants has also been tested in vitro for anti-bacterial properties, [11][12][13][14] whereby mesenchymal and embryonic stem cells were unable to grow on surfaces with particular TiO 2 nanotube dimen-sions 14 .…”