Potential side effects of antibacterial coatings in orthopaedic implants: A systematic review of clinical studies

Abstract

Objective: The systematic review aimed to determine the potential side effects of antibacterial coatings in orthopaedic implants.Methods: Publications were searched in the databases of Embase, PubMed, Web of Science and Cochrane Library using predetermined keywords up to 31 October 2022. Clinical studies reporting side effects of the surface or coating materials were included.Results: A total of 23 studies (20 cohort studies and three case reports) reporting the concerns about the side effects of antibacterial coatings were identified. Three types of coating materials, silver, iodine and gentamicin were included. All of studies raised the concerns regarding safety of antibacterial coatings, and the occurrence of adverse events was observed in seven studies. The main side effect of silver coatings was the development of argyria. For iodine coatings, only one anaphylactic case was reported as an adverse event. No systemic or other general side effects were reported for gentamicin.Conclusion: Clinical studies on the side effects of antibacterial coatings were limited. Based on the available outcomes, the most reported side effects of antibacterial coatings in clinical use were argyria with silver coatings. However, researchers should always pay attention to the potential side effects of antibacterial materials, such as systematic or local toxicity and allergy.

What to Know about Antimicrobial Coatings in Arthroplasty: A Narrative Review

“…Nonetheless, as reported by Li et al [38] as well as Fiore et al [8], the blood silver concentrations with modern implants recorded in the literature are far from the threshold of silver poisoning, and no major systemic side effects have been reported recently. In agreement, Smolle et al documented no systemic effects in their patient's cohort in 2022, but they proposed rigorous monitoring of silver concentrations in patients with these material-containing implants [42].…”

“…In agreement, Smolle et al documented no systemic effects in their patient's cohort in 2022, but they proposed rigorous monitoring of silver concentrations in patients with these material-containing implants [42]. Concerning local effects, they can be split into two main parts [8,10,28,29,38,39]. The first one is argyria, which consists of a local blue-grayish skin discoloration due to silver accumulation [8,28,38,39].…”

“…Donati et al, in their scanning electron microscopy (SEM) analysis of retrieved implants at 18 and 27 months, showed wear of the coating, with silver particles almost depleted [30]. Despite this, what the literature investigates and what especially concerns surgeons in clinical practice are silver drawbacks [8,10,28,29,38]. Both systemic and local side effects have been documented with high silver concentrations [8,10,28,29,38].…”

“…Despite this, what the literature investigates and what especially concerns surgeons in clinical practice are silver drawbacks [8,10,28,29,38]. Both systemic and local side effects have been documented with high silver concentrations [8,10,28,29,38]. Regarding systemic consequences, cases of nephrotoxicity, hepatopathy, leukopenia, and peripheral neuropathies have been cited [8,38,39].…”

“…Both systemic and local side effects have been documented with high silver concentrations [8,10,28,29,38]. Regarding systemic consequences, cases of nephrotoxicity, hepatopathy, leukopenia, and peripheral neuropathies have been cited [8,38,39].…”