The Effect of Surface Modification of Ti13Zr13Nb Alloy on Adhesion of Antibiotic and Nanosilver-Loaded Bone Cement Coatings Dedicated for Application as Spacers

Abstract

Spacers, in terms of instruments used in revision surgery for the local treatment of postoperative infection, are usually made of metal rod covered by antibiotic-loaded bone cement. One of the main limitations of this temporary implant is the debonding effect of metal–bone cement interface, leading to aseptic loosening. Material selection, as well as surface treatment, should be evaluated in order to minimize the risk of fraction and improve the implant-cement fixation the appropriate manufacturing. In this study, Ti13Zr13Nb alloys that were prepared by Selective Laser Melting and surface treated were coated with bone cement loaded with either gentamicin or nanosilver, and the effects of such alloy modifications were investigated. The SLM-made specimens of Ti13Zr13Nb were surface treated by sandblasting, etching, or grounding. For each treatment, Scanning Electron Microscope (SEM), contact profilometer, optical tensiometer, and nano-test technique carried out microstructure characterization and surface analysis. The three types of bone cement i.e., pure, containing gentamicin and doped with nanosilver were applied to alloy surfaces and assessed for cement cohesion and its adhesion to the surface by nanoscratch test and pull-off. Next, the inhibition of bacterial growth and cytocompatibility of specimens were investigated by the Bauer-Kirby test and MTS assay respectively. The results of each test were compared to the two control groups, consisting of commercially available Ti13Zr13Nb and untreated SLM-made specimens. The highest adhesion bone cement to the titanium alloy was obtained for specimens with high nanohardness and roughness. However, no explicit relation of adhesion strength with wettability and surface energy of alloy was observed. Sandblasting or etching were the best alloys treatments in terms of the adhesion of either pure or modified bone cements. Antibacterial additives for bone cement affected its properties. Gentamicin and nanosilver allowed for adequate anti-bacterial protection while maintaining the overall biocompatibility of obtained spacers. However, they had different effects on the cement’s adhesive capacity or its own cohesion. Furthermore, the addition of silver nanoparticles improved the nanomechanical properties of bone cements. Surface treatment and method of fabrication of titanium affected surface parameters that had a significant impact on cement-titanium fixation.

A systematic review on improving the biocompatibility of titanium implants using nanoparticles

“…The authors also evaluated the antibacterial properties of the prepared surfaces against S. aureus and AgNPs containing surfaces exhibited a distinct inhibition of bacterial growth, while the nanoparticle deficient surfaces showed minimal effect on bacterial growth. These results are in agreement with those observed by [18] and [19] which showed that modifying Ti specimen surfaces with nanosilver does not deteriorate the overall biocompatibility of the material construct while allowing for adequate antibacterial protection.…”

“…Applications of NPs in the selected research papers was mainly in the form of embedding the ultrafine structures into a coating material such as nanosilver-loaded bone cement coatings [18], nanosilver-loaded dopamine coatings [36], AgNP-filled hydrogen titanate nanotube layer [30], Ag nanoparticle-loaded TiO 2 nanorods (NRDs) coatings [32], hydroxyapatite (HA) coatings [34], thin mussel adhesive protein (Mefp-1)/AgNP composite film [24] and crosslinked gelatin/SG composite coating [20]. The incorporation of NPs into such surface modification coatings facilitates the slow release of ions from NPs and the subsequent reduction of toxicity and prolonged antibacterial effects.…”

Mechanical and Corrosion Properties of Laser Surface-Treated Ti13Nb13Zr Alloy with MWCNTs Coatings

“…The improvement of titanium biomaterials properties has been obtained by subjecting them to ion implantation [13,14], plating [15,16] and nitriding [17,18]. A popular method of obtaining better properties of the titanium alloys tested is coating them using silicates [19], chitosan [20,21], or phosphates including hydroxyapatite (HAp) [22][23][24][25] and nanoHAp [7,[26][27][28]-together with their composite combinations with other elements [26,[28][29][30][31][32][33]-thus facilitating better adhesion and antibacterial properties. Carbon and diamond-like coatings [34][35][36][37][38][39] and their composite combinations with other elements [40][41][42], as well as carbon nanotubes (CNTs) [41,[43][44][45] and their composite combinations with other elements [31,45,46] have been tested to obtain better mechanical (especially nanohardness) and anti-corrosive properties.…”

“…These results, among others, consist of improvement of mechanical properties, increase in their hardness and often improvement of their anti-corrosion properties. However, these positive changes are often accompanied by deterioration in surface quality, which is one of the disadvantages of laser surface modification techniques of most materials [17,23,33,44,[52][53][54]56,57,[59][60][61][62].…”

Biological Responses of Ceramic Bone Spacers Produced by Green Processing of Additively Manufactured Thin Meshes

“…Bone spacers are generally used during revision surgery to control postoperative infection as temporary implants [17]. Poly-methyl-methacrylate (PMMA) cement is the most known material used as a bone spacer [18].…”