Vitamin E blended Uhmwpe may have the potential to reduce bacterial adhesive ability

Abstract

Biomaterial-associated infection (BAI), a clinical problem resulting in septic failure of joint replacement implants, is initiated by bacterial adhesion, often by Staphylococcus epidermidis. Ultra high molecular weight polyethylene (UHMWPE) is a material of choice for joint replacement; reducing the adhesion of S. epidermidis to the polymer could be a means to decrease infection. We examined the adhesion of two ATCC and one clinical strain of S. epidermidis to standard polyethylene (PE), vitamin E blended UHMWPE (VE-PE), and oxidized UHMWPE (OX-PE) after different incubation times: a significant (p < 0.01) decrease in the adhered staphylococci on VE-PE and a significantly higher incidence of the dislodged biofilm bacteria on OX-PE was observed compared with that registered on PE. With attenuated total reflectance (ATR)-FTIR spectroscopy before and after suspension in bacterial medium for 48 h, new absorptions were observed mainly in OX-PE, indicating adsorption of protein-like substances on the polymer surface. We hypothesized that the different hydrophilicity of the surfaces with different chemical characteristics influenced protein adsorption and bacterial adhesion. These results may have clinical implications concerning the prevention of septic loosening: the VE-PE could have the potential to reduce S. epidermidis adhesive ability if the preliminary data observed in these selected strains is further confirmed, as diversity among clinical strains is well known. ß

Does Vitamin E-blended UHMWPE Prevent Biofilm Formation?

“…An important limitation of that study was that 90 minutes of bacterial exposure may not have provided an accurate measure for biofilm formation on the surface of a material since bacteria require roughly 24 hours to form a mature biofilm [23]. In a study by Banche et al [1], three material types were exposed to an initial inoculum of 10 7 CFUs/mL for various times including 24 hours and 48 hours. These tests were not performed under flow but rather under static conditions.…”

“…Data suggest that implant materials alone, such as black silicon and silicon nitride, may have the ability to prevent bacterial attachment or eradicate bacteria that come in contact with the material [7,10]. Additionally, previous reports have suggested that the addition of vitamin E to UHMWPE may prevent the adhesion of bacteria to its surface and thus reduce the risk of biofilm formation and subsequent infection [1,5,12]. It has been proposed that bacteria may have increased affinity to adhere to oxidized UHMWPE surfaces and form biofilms.…”

“…It has been proposed that bacteria may have increased affinity to adhere to oxidized UHMWPE surfaces and form biofilms. Thus, the addition of vitamin E may reduce oxidation and result in a reduction of biofilm formation on the surface [1].…”

“…Second, although statistically significant differences were reported in bacterial attachment on UHMWPE surfaces, these differences may not be clinically significant. More specifically, Banche et al [1] reported a statistically significant difference in bacterial adhesion when comparing the attachment of Staphylococcus epidermidis to oxidized UHMWPE (7.25 9 10 7 colony-forming units [CFUs]/mL) to vitamin E-blended UHMWPE (1.27 9 10 7 CFUs/mL). Animal model data and clinical data have indicated that as little as 10 2 or 10 5 CFUs/g of tissue may be pathogenic [2,11].…”

Interplay between surface properties of standard, vitamin E blended and oxidised ultra high molecular weight polyethylene used in total joint replacement and adhesion ofStaphylococcus aureusandEscherichia coli

“…Biomaterial associate infections (BAI) are still an issue in total joint replacement (TJR) surgery, [1][2][3][4] where often result in a series of implant-related sequelae that can lead to implant removal with clinical and economic consequences of significant importance. 5 The initial bacterial adhesion and subsequent growth of microorganisms to the biomaterials implant surface are complex processes related to physico-chemical interactions between substratum and microorganisms.…”