Molecular engineering of an orthopaedic implant: from bench to bedside

Abstract

The use of metallic implants has revolutionised the practice of orthopaedic surgery. While the safety and biocompatibility of these devices are excellent, a small percentage becomes infected. These infections are due to the formation of a biofilm that harbours bacteria encased in a complex extracellular matrix. The matrix serves as a barrier to immune surveillance as well as limiting the biocidal effects of systemic and local antibiotics. The objective of the review is to describe a novel approach to controlling implant infection using an antibiotic that is linked to titanium through a self-assembled monolayer of siloxy amines. We show that the hybrid-engineered surface is stable, biocompatible and resists colonisation by bacterial species most commonly associated with implant-related infections. Studies with rodent bone infection models suggest that the engineered titanium surface prevents bone infection. Results of a very recent investigation utilising a sheep model of infection indicate that the titanium-tethered antibiotic controls infection without compromising bone formation and remodelling. From all of these perspectives, the tethered antibiotic holds promise of providing a novel and practical approach to reducing implant-associated infections.

Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

“…Initiatives to minimize bacterial colonization at the time of insertion have been studied in the past with slow permeation in the clinical setting [1,39,48]. Several preclinical and clinical studies support the use of copper alloy touch surfaces to reduce the burden of bacteria in healthcare settings [10,11,33], but few studies support the use of copper implants to reduce periprosthetic infections [6,18,27,41].…”

“…Clinical translation has been limited by cytotoxicity concerns, poor adhesive properties, and lack of homogeneity and complexity of coating methods [1,39,48]. Silvercoated megaprostheses are currently available in Europe for clinical use in tumor surgery.…”

Vitamin D and Sphingolipids: Role in Bone and Neural System

“…Several ovariectomized large animals might be also used as models of osteoporosis, such as the dog, the pig, the sheep, and the nonhuman primates [68]. In particular, the sheep is also well established as a model for human bone loss/osteoporosis in orthopedic research [69]. Some limits can be the largeness in size and the difficulty to manage relatively expensive experiments.…”

CORR Insights®: Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

“…It follows that technologies that might inhibit organism viability, adhesion, and biofilm formation should successfully prevent and possibly treat PJI. This is exactly what many in the field have been attempting to accomplish [1,8,9], experimenting with passive surface treatments that inhibit bacterial adhesion and active surface treatments, which elute bactericidal agents. Researchers have applied antibiotics, organic and inorganic antimicrobial agents, and adhesion-resistant coatings to implants in an attempt to inhibit the formation of a biofilm.…”