Innovative antimicrobial coating of titanium implants with iodine

Abstract

BackgroundPostoperative infection associated with implants remains a serious complication in orthopedic surgery. Several biomaterial surface treatments have been proposed as a means of reducing the incidence of implant-associated infections. In this study, a clinical trial was performed using an iodine-supported titanium that suppresses the microbial activities.MethodsA total of 222 patients with postoperative infection or compromised status were treated using iodine-supported titanium implants. The mean age of the patients was 49.4 years (range 5–85 years). One hundred twenty-seven patients were male and 95 were female. In 158 patients, iodine-supported implants were used to prevent infection, such as compromised hosts and conditions, and in 64 patients to treat active infection. White blood cell (WBCs) and C-reactive protein (CRP) levels were measured pre- and postoperatively in all patients. To confirm whether iodine from the implant affected physiological functions, thyroid hormone levels in the blood were examined. Both examinations were conducted sequentially for a year. Radiological evaluations were performed regularly after the operation. The chronological changes of the iodine amount were evaluated using half pins removed after completion of external fixation.ResultsThe mean follow-up period was 18.4 months (range 3–44 months). Acute infection developed in three tumor cases among the 158 patients on preventive therapy. All three recovered without removal of the implants. Infection was cured in all 64 patients with infection. Median WBC levels were in the normal range, and median CRP levels returned to <0.5 within 4 weeks after surgery. Abnormalities of thyroid gland function were not detected. None of the patients experienced loosening of the implants. There were two patients with mechanical implant failure, which was treated by re-implantation. Excellent bone ingrowth and ongrowth were found around all hip and tumor prostheses. One year later, the amount of iodine on external fixation pins remained about 20–30 %.ConclusionsIodine-supported titanium implants can be very effective for preventing and treating infections after orthopedic surgery. Cytotoxicity and adverse effects were not detected.

Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology

“…The antimicrobial effect acts not only on general bacteria but also on viruses, tubercle bacilli, and even fungi. In addition, iodine does not cause drug resistance as induced by the administration of antibiotics [15]. By application of these advantages, the results of this study acquired good clinical outcome.…”

Prevenzione delle infezioni peri-protesiche mediante rivestimento riassorbibile anti-batterico: un nuovo approccio?

“…Sebbene siano stati proposti diversi rivestimenti antibatterici per prevenire la colonizzazione batterica e la formazione di biofilm, le tecnologie disponibili sono ben lungi dall'essere applicabili su larga scala, a causa di varie limitazioni, tra cui i possibili effetti a lungo termine sulla resistenza batterica e sull'osteointegrazione, mentre questioni normative e costi hanno finora ritardato l'utilizzo su vasta scala di molte tecnologie [3,[6][7][8]. L'utilizzo di un idrogel rapidamente riassorbibile, in grado di veicolare localmente composti antibatterici, rappresenta una nuova alternativa in questo panorama.…”

“…Una volta che un biofilm si è formato, è difficile da trattare poiché i batteri sono protetti sia dalla fagocitosi sia da eventuali antibiotici. Per tutti questi motivi, avendo constatato i limiti degli antibiotici sistemici nel trattamento e nella prevenzione delle infezioni correlate a biofilm, la ricerca si è rivolta allo sviluppo di rivestimenti dei biomateriali impiantabili, allo scopo di prevenire l'adesione e colonizzazione batterica e la formazione del biofilm [6][7][8]. Tuttavia le tecnologie finora studiate sono state ben lungi dal soddisfare tutte le esigenze di sicurezza, efficacia, facilità d'uso, costi e adempimenti regolatori che sono necessari per un impiego su larga scala.…”

Prevention of pin tract infection with iodine-supported titanium pins

“…1) [9]. This coating can be applied on various types of titanium implants, and a clinical trial has been ongoing since 2008 [10].…”