1
|
Ma C, de Barros NR, Zheng T, Gomez A, Doyle M, Zhu J, Nanda HS, Li X, Khademhosseini A, Li B. 3D Printing and Surface Engineering of Ti6Al4V Scaffolds for Enhanced Osseointegration in an In Vitro Study. Biomimetics (Basel) 2024; 9:423. [PMID: 39056864 PMCID: PMC11274417 DOI: 10.3390/biomimetics9070423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024] Open
Abstract
Ti6Al4V superalloy is recognized as a good candidate for bone implants owing to its biocompatibility, corrosion resistance, and high strength-to-weight ratio. While dense metal implants are associated with stress shielding issues due to the difference in densities, stiffness, and modulus of elasticity compared to bone tissues, the surface of the implant/scaffold should mimic the properties of the bone of interest to assure a good integration with a strong interface. In this study, we investigated the additive manufacturing of porous Ti6Al4V scaffolds and coating modification for enhanced osteoconduction using osteoblast cells. The results showed the successful fabrication of porous Ti6Al4V scaffolds with adequate strength. Additionally, the surface treatment with NaOH and Dopamine Hydrochloride (DOPA) promoted the formation of Dopamine Hydrochloride (DOPA) coating with an optimized coating process, providing an environment that supports higher cell viability and growth compared to the uncoated Ti6Al4V scaffolds, as demonstrated by the higher proliferation ratios observed from day 1 to day 29. These findings bring valuable insights into the surface modification of 3D-printed scaffolds for improved osteoconduction through the coating process in solutions.
Collapse
Affiliation(s)
- Changyu Ma
- Autonomy Research Center for STEAHM, California State University Northridge, Northridge, CA 91324, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| | | | - Tianqi Zheng
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Alejandro Gomez
- Autonomy Research Center for STEAHM, California State University Northridge, Northridge, CA 91324, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| | - Marshall Doyle
- Autonomy Research Center for STEAHM, California State University Northridge, Northridge, CA 91324, USA
| | - Jianhao Zhu
- Autonomy Research Center for STEAHM, California State University Northridge, Northridge, CA 91324, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| | - Himansu Sekhar Nanda
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
- Discipline of Mechanical Engineering, Indian Institute of Information Technology, Design and Manufacturing, Jabalpur 482005, India
| | - Xiaochun Li
- Department of Mechanical and Aerospace Engineering, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| | - Bingbing Li
- Autonomy Research Center for STEAHM, California State University Northridge, Northridge, CA 91324, USA
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA 90024, USA
| |
Collapse
|
2
|
Li H, Wang D, Zhang W, Xu G, Xu C, Liu W, Li J. Potential side effects of antibacterial coatings in orthopaedic implants: A systematic review of clinical studies. Front Bioeng Biotechnol 2023; 11:1111386. [PMID: 36845182 PMCID: PMC9947536 DOI: 10.3389/fbioe.2023.1111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/31/2023] [Indexed: 02/11/2023] Open
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.
Collapse
Affiliation(s)
- Hua Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Daofeng Wang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Wupeng Zhang
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,School of Medicine, Nankai University, Tianjin, China
| | - Gaoxiang Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China
| | - Cheng Xu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Wanheng Liu
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| | - Jiantao Li
- Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, Beijing, China,*Correspondence: Cheng Xu, ; Wanheng Liu, ; Jiantao Li,
| |
Collapse
|
3
|
Pierre C, Bertrand G, Pavy I, Benhamou O, Rey C, Roques C, Combes C. Antibacterial Electrodeposited Copper-Doped Calcium Phosphate Coatings for Dental Implants. J Funct Biomater 2022; 14:jfb14010020. [PMID: 36662066 PMCID: PMC9863956 DOI: 10.3390/jfb14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Dental implants provide a good solution for the replacement of tooth roots. However, the full restoration of tooth functions relies on the bone-healing period before positioning the abutment and the crown on the implant, with the associated risk of post-operative infection. This study aimed at developing a homogeneous and adherent thin calcium phosphate antibacterial coating on titanium dental implants by electrodeposition to favor both implant osseointegration and to limit peri-implantitis. By combining global (XRD, FTIR-ATR, elemental titration) and local (SEM, Raman spectroscopy on the coating surface and thickness) characterization techniques, we determined the effect of electrodeposition time on the characteristics and phases content of the coating and the associated mechanism of its formation. The 1-min-electrodeposited CaP coating (thickness: 2 ± 1 μm) was mainly composed of nano-needles of octacalcium phosphate. We demonstrated its mechanical stability after screwing and unscrewing the dental implant in an artificial jawbone. Then, we showed that we can reach a high copper incorporation rate (up to a 27% Cu/(Cu+Ca) molar ratio) in this CaP coating by using an ionic exchange post-treatment with copper nitrate solution at different concentrations. The biological properties (antibiofilm activity and cytotoxicity) were tested in vitro using a model of mixed bacteria biofilm mimicking peri-implantitis and the EN 10993-5 standard (direct contact), respectively. An efficient copper-doping dose was determined, providing an antibiofilm property to the coating without cytotoxic side effects. By combining the electrodeposition and copper ionic exchange processes, we can develop an antibiofilm calcium phosphate coating on dental implants with a tunable thickness and phases content.
Collapse
Affiliation(s)
- Camille Pierre
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP-ENSIACET, 31030 Toulouse, France
| | - Ghislaine Bertrand
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP-ENSIACET, 31030 Toulouse, France
| | - Iltaf Pavy
- Laboratoire de Génie Chimique, Université de Toulouse, CNRS, Université Paul Sabatier, Faculté des Sciences Pharmaceutiques, 31062 Toulouse, France
| | - Olivier Benhamou
- Arts Loi Dental Clinic, Rue de la Loi 28, 1040 Bruxelles, Belgium
| | - Christian Rey
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP-ENSIACET, 31030 Toulouse, France
| | - Christine Roques
- Laboratoire de Génie Chimique, Université de Toulouse, CNRS, Université Paul Sabatier, Faculté des Sciences Pharmaceutiques, 31062 Toulouse, France
| | - Christèle Combes
- CIRIMAT, Université de Toulouse, CNRS, Toulouse INP-ENSIACET, 31030 Toulouse, France
| |
Collapse
|
4
|
In Vitro Bioactivity and Antibacterial Effects of a Silver-Containing Mesoporous Bioactive Glass Film on the Surface of Titanium Implants. Int J Mol Sci 2022; 23:ijms23169291. [PMID: 36012555 PMCID: PMC9408939 DOI: 10.3390/ijms23169291] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/13/2022] [Accepted: 08/15/2022] [Indexed: 12/29/2022] Open
Abstract
Peri-implantitis is defined as a bacterial infection-induced inflammation and suppuration of soft and hard tissues surrounding a dental implant. If bacteria further invade the alveolar bone, they can easily cause bone loss and even lead to the early failure of a dental implant surgery. In the present study, an 80SiO2–15CaO–5P2O5 mesoporous bioactive glass film system containing 1, 5, and 10 mol% of silver was prepared on titanium implant discs (MBG–Ag–coated Ti) using sol-gel and spin coating methods. The wettability and adhesion strength of the films were evaluated using contact angle measurements and adhesion strength tests, respectively. The phase composition, chemical bonding, morphology, and oxidation states of the films were analyzed via X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS), and X-ray photoelectron spectroscopy (XPS). In vitro bioactivity analysis of the films was performed by immersion in a simulated body fluid (SBF) for 24 h. Disk diffusion tests were performed on the early colonizing bacteria Aggregatibacter actinomycetemcomitans and Streptococcus mutans to evaluate the antibacterial ability of the films. A silver-containing mesoporous bioactive glass film with excellent biocompatibility and antibacterial properties was successfully prepared.
Collapse
|
5
|
Titanium or Biodegradable Osteosynthesis in Maxillofacial Surgery? In Vitro and In Vivo Performances. Polymers (Basel) 2022; 14:polym14142782. [PMID: 35890557 PMCID: PMC9316877 DOI: 10.3390/polym14142782] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 02/06/2023] Open
Abstract
Osteosynthesis systems are used to fixate bone segments in maxillofacial surgery. Titanium osteosynthesis systems are currently the gold standard. However, the disadvantages result in symptomatic removal in up to 40% of cases. Biodegradable osteosynthesis systems, composed of degradable polymers, could reduce the need for removal of osteosynthesis systems while avoiding the aforementioned disadvantages of titanium osteosyntheses. However, disadvantages of biodegradable systems include decreased mechanical properties and possible foreign body reactions. In this review, the literature that focused on the in vitro and in vivo performances of biodegradable and titanium osteosyntheses is discussed. The focus was on factors underlying the favorable clinical outcome of osteosyntheses, including the degradation characteristics of biodegradable osteosyntheses and the host response they elicit. Furthermore, recommendations for clinical usage and future research are given. Based on the available (clinical) evidence, biodegradable copolymeric osteosyntheses are a viable alternative to titanium osteosyntheses when applied to treat maxillofacial trauma, with similar efficacy and significantly lower symptomatic osteosynthesis removal. For orthognathic surgery, biodegradable copolymeric osteosyntheses are a valid alternative to titanium osteosyntheses, but a longer operation time is needed. An osteosynthesis system composed of an amorphous copolymer, preferably using ultrasound welding with well-contoured shapes and sufficient mechanical properties, has the greatest potential as a biocompatible biodegradable copolymeric osteosynthesis system. Future research should focus on surface modifications (e.g., nanogel coatings) and novel biodegradable materials (e.g., magnesium alloys and silk) to address the disadvantages of current osteosynthesis systems.
Collapse
|
6
|
Hadrup N, Sharma AK, Jacobsen NR, Loeschner K. Distribution, metabolism, excretion, and toxicity of implanted silver: a review. Drug Chem Toxicol 2021; 45:2388-2397. [PMID: 34455878 DOI: 10.1080/01480545.2021.1950167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Some implantable medical devices contain silver. We aimed to assess at what amount implanted silver becomes toxic. Silver was elevated in bodily fluids and tissues surrounding silver-containing implants. Silver released from implants also distributes to blood and other tissues; there is evidence to suggest silver can pass the blood-brain-barrier. Silver can be deposited as nano-sized particles in various tissues. Such particles, in addition to silver, often contain other elements too, e.g., selenium and sulfur. Silver released from implants seems to stay in the body for long periods (years). Reported excretion pathways following implantation are urinary and fecal ones. Reported toxicological effects were virtually all local reactions surrounding the implants. Argyria is a blue-gray discoloration of the skin due to deposited silver granules. Localized argyria has been described after the implantation of acupuncture needles and silver-coated prostheses, although the presence of silver was tested only for and shown in the former. Other toxicological effects include local tissue reactivity and examples of neurotoxic and vascular effects. We did not include genotoxicity studies in the present publication as we recently evaluated silver to be genotoxic. Carcinogenicity studies were absent. We conclude that local toxicity of implanted silver can be foreseen in some situations.
Collapse
Affiliation(s)
- Niels Hadrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anoop K Sharma
- Division for Diet, Disease Prevention and Toxicology, Group for Chemical Risk Assessment and GMO, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Nicklas R Jacobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Katrin Loeschner
- Division for Food Technology, Research Group for Analytical Food Chemistry, National Food Institute, Technical University of Denmark, Lyngby, Denmark
| |
Collapse
|
7
|
Quinn J, McFadden R, Chan CW, Carson L. Titanium for Orthopedic Applications: An Overview of Surface Modification to Improve Biocompatibility and Prevent Bacterial Biofilm Formation. iScience 2020; 23:101745. [PMID: 33235984 PMCID: PMC7670191 DOI: 10.1016/j.isci.2020.101745] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Titanium and its alloys have emerged as excellent candidates for use as orthopedic biomaterials. Nevertheless, there are often complications arising after implantation of orthopedic devices, most notably prosthetic joint infection and aseptic loosening. To ensure that implanted devices remain functional in situ, innovation in surface modification has attracted much attention in the effort to develop orthopedic materials with optimal characteristics at the biomaterial-tissue interface. This review will draw together metallurgy, surface engineering, biofilm microbiology, and biomaterial science. It will serve to appreciate why titanium and its alloys are frequently used orthopedic biomaterials and address some of the challenges facing these biomaterials currently, including the significant problem of device-associated infection. Finally, the authors shall consolidate and evaluate surface modification techniques employed to overcome some of these issues by offering a unique perspective as to the direction in which research is headed from a broad, interdisciplinary point of view.
Collapse
Affiliation(s)
- James Quinn
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| | - Ryan McFadden
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Ashby Building, Stranmillis Road, Belfast BT9 5AH, UK
| | - Chi-Wai Chan
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Ashby Building, Stranmillis Road, Belfast BT9 5AH, UK
| | - Louise Carson
- School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast BT9 7BL, UK
| |
Collapse
|
8
|
Xue T, Attarilar S, Liu S, Liu J, Song X, Li L, Zhao B, Tang Y. Surface Modification Techniques of Titanium and its Alloys to Functionally Optimize Their Biomedical Properties: Thematic Review. Front Bioeng Biotechnol 2020; 8:603072. [PMID: 33262980 PMCID: PMC7686851 DOI: 10.3389/fbioe.2020.603072] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022] Open
Abstract
Depending on the requirements of specific applications, implanted materials including metals, ceramics, and polymers have been used in various disciplines of medicine. Titanium and its alloys as implant materials play a critical role in the orthopedic and dental procedures. However, they still require the utilization of surface modification technologies to not only achieve the robust osteointegration but also to increase the antibacterial properties, which can avoid the implant-related infections. This article aims to provide a summary of the latest advances in surface modification techniques, of titanium and its alloys, specifically in biomedical applications. These surface techniques include plasma spray, physical vapor deposition, sol-gel, micro-arc oxidation, etc. Moreover, the microstructure evolution is comprehensively discussed, which is followed by enhanced mechanical properties, osseointegration, antibacterial properties, and clinical outcomes. Future researches should focus on the combination of multiple methods or improving the structure and composition of the composite coating to further enhance the coating performance.
Collapse
Affiliation(s)
- Tong Xue
- School of Metallurgical Engineering, Xi'an University of Architecture and Technology, Xi'an, China
| | - Shokouh Attarilar
- Department of Pediatric Orthopaedics, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,State Key Laboratory of Metal Matrix Composites, School of Material Science and Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Shifeng Liu
- School of Metallurgical Engineering, Xi'an University of Architecture and Technology, Xi'an, China
| | - Jia Liu
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Xi Song
- School of Metallurgical Engineering, Xi'an University of Architecture and Technology, Xi'an, China
| | - Lanjie Li
- Chengsteel Group Co., Ltd., HBIS Group Co., Ltd., Chengde, China
| | - Beibei Zhao
- Chengsteel Group Co., Ltd., HBIS Group Co., Ltd., Chengde, China
| | - Yujin Tang
- Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| |
Collapse
|
9
|
Wyatt MC, Foxall-Smith M, Roberton A, Beswick A, Kieser DC, Whitehouse MR. The use of silver coating in hip megaprostheses: a systematic review. Hip Int 2019; 29:7-20. [PMID: 30442019 DOI: 10.1177/1120700018811070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Retrospective studies of silver-coated hip implants have demonstrated promising results and safety profile, however, the potential benefits are so far unproven in prospective studies. Silver-coated implants may have a role in patients undergoing revision or primary surgery with a high risk of infection but as yet there are no human studies investigating silver in primary hip arthroplasty. Adequately powered robust prospective studies are needed in this area to determine if silver-coated implants would be efficacious and cost-effective. The purpose of this systematic review article is to review the current literature regarding the use of silver in hip arthroplasty. Our review showed that there is some encouraging evidence that silver coatings can reduce infection.
Collapse
Affiliation(s)
- Michael C Wyatt
- 1 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, New Zealand
| | - Michael Foxall-Smith
- 2 Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,3 North Devon District Hospital, Barnstaple, UK
| | - Andrew Roberton
- 2 Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,3 North Devon District Hospital, Barnstaple, UK
| | - Andrew Beswick
- 2 Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK
| | - David C Kieser
- 1 Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago Christchurch, New Zealand
| | - Michael R Whitehouse
- 4 National Institute for Health Research Bristol Biomedical Research Centre, Bristol, UK.,5 Faculty of Health Sciences, University of Bristol, UK
| |
Collapse
|
10
|
Silver-coated megaprostheses in the proximal femur in patients with sarcoma. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:79-85. [DOI: 10.1007/s00590-018-2270-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
|
11
|
Shevtsov MA, Yudintceva NM, Blinova MI, Voronkina IV, Suslov DN, Galibin OV, Gavrilov DV, Akkaoui M, Raykhtsaum G, Albul AV, Pitkin E, Pitkin M. Evaluation of the temporary effect of physical vapor deposition silver coating on resistance to infection in transdermal skin and bone integrated pylon with deep porosity. J Biomed Mater Res B Appl Biomater 2018; 107:169-177. [PMID: 29573163 DOI: 10.1002/jbm.b.34108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 02/06/2023]
Abstract
Periprosthetic infection via skin-implant interface is a leading cause of failures and revisions in direct skeletal attachment of limb prostheses. Implants with deep porosity fabricated with skin and bone integrated pylons (SBIP) technology allow for skin ingrowth through the implant's structure creating natural barrier against infection. However, until the skin cells remodel in all pores of the implant, additional care is required to prevent from entering bacteria to the still nonoccupied pores. Temporary silver coating was evaluated in this work as a means to provide protection from infection immediately after implantation followed by dissolution of silver layer in few weeks. A sputtering coating with 1 µm thickness was selected to be sufficient for fighting infection until the deep ingrowth of skin in the porous structure of the pylon is completed. In vitro study showed less bacterial (Staphylococcus aureus, Staphylococcus epidermidis, and Pseudomonas aeruginosa) growth on silver coated tablets compared to the control group. Analysis of cellular density of MG-63 cells, fibroblasts, and mesenchymal stem cells (MSCs) showed that silver coating did not inhibit the cell growth on the implants and did not affect cellular functional activity. The in vivo study did not show any postoperative complications during the 6-month observation period in the model of above-knee amputation in rabbits when SBIP implants, either silver-coated or untreated were inserted into the bone residuum. Three-phase scintigraphy demonstrated angiogenesis in the pores of the pylons. The findings suggest that a silver coating with well-chosen specifications can increase the safety of porous implants for direct skeletal attachment. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 107B: 169-177, 2019.
Collapse
Affiliation(s)
- Maxim A Shevtsov
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia.,Technical University of Munich, Munich, Germany.,Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia.,Polenov Russian Scientific Research Institute of Neurosurgery, St. Petersburg, Russia
| | - Natalia M Yudintceva
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Miralda I Blinova
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Irina V Voronkina
- Institute of Cytology of the Russian Academy of Sciences (RAS), St. Petersburg, Russia
| | - Dmitriy N Suslov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Oleg V Galibin
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | - Dmitriy V Gavrilov
- Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - Andrey V Albul
- Veterinary Clinic "Neurology, Traumatology and Intensive Therapy of Doctor Sotnikov V.V.,", St. Petersburg, Russia
| | - Emil Pitkin
- Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Pitkin
- Poly-Orth International, Sharon, Massachusetts.,Tufts University School of Medicine, Boston, Massachusetts
| |
Collapse
|
12
|
Schmidt-Braekling T, Streitbuerger A, Gosheger G, Boettner F, Nottrott M, Ahrens H, Dieckmann R, Guder W, Andreou D, Hauschild G, Moellenbeck B, Waldstein W, Hardes J. Silver-coated megaprostheses: review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:483-489. [PMID: 28265758 DOI: 10.1007/s00590-017-1933-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/26/2017] [Indexed: 01/06/2023]
Abstract
Periprosthetic infection remains one of the most serious complications following megaendoprostheses. Despite a large number of preventive measures that have been introduced in recent years, it has not been possible to further reduce the rate of periprosthetic infection. With regard to metallic modification of implants, silver in particular has been regarded as highly promising, since silver particles combine a high degree of antimicrobial activity with a low level of human toxicity. This review provides an overview of the history of the use of silver as an antimicrobial agent, its mechanism of action, and its clinical application in the field of megaendoprosthetics. The benefits of silver-coated prostheses could not be confirmed until now. However, a large number of retrospective studies suggest that the rate of periprosthetic infections could be reduced by using silver-coated megaprostheses.
Collapse
Affiliation(s)
- Tom Schmidt-Braekling
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
| | - Arne Streitbuerger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Georg Gosheger
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA
| | - Markus Nottrott
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Helmut Ahrens
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Ralf Dieckmann
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wiebke Guder
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Dimosthenis Andreou
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Gregor Hauschild
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Burkhard Moellenbeck
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| | - Wenzel Waldstein
- Department of Orthopedics, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Jendrik Hardes
- Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany
| |
Collapse
|
13
|
Silver-Coated Hip Megaprosthesis in Oncological Limb Savage Surgery. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9079041. [PMID: 27642605 PMCID: PMC5011498 DOI: 10.1155/2016/9079041] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/16/2016] [Accepted: 07/10/2016] [Indexed: 02/07/2023]
Abstract
Silver coating has demonstrated good antimicrobial activity and low toxicity. Silver-coated megaprostheses have been introduced in oncological musculoskeletal surgery considering the high rate of infection. We conducted a retrospective analysis on 68 cases of primary or metastatic bone tumors, affecting the proximal femur, treated between 2005 and 2016 with wide margins resection and tumor implants reconstruction. All patients were treated by the same surgeon, with antibiotic prophylaxis according to a standard protocol. In 55.9% of patients silver-coated hip hemiarthroplasty was implanted; in the remaining 44.1% uncoated megaprostheses were implanted. Patients were reevaluated recording the complications and focusing the analysis on infective complications. The average follow-up was 46.5 months. No patient has shown any sign of local or general silver toxicity. A SEM analysis was conducted on the 3-silver-coated hip hemiarthroplasty explanted confirming a severe degradation with a small amount of residual silver on the coating surface. Silver-coated hip prostheses have a lower rate of early infection than traditional implants but showed a reduction of antimicrobial activity for silver coating wear. We recommend using silver-coated prosthesis as primary implants for limb salvage surgery, in primary or metastatic bone tumors affecting the proximal femur, considering the absence of signs of toxicity and the lower rate of early infection.
Collapse
|
14
|
Surface Treatments of Titanium with Antibacterial Agents for Implant Applications. MODERN ASPECTS OF ELECTROCHEMISTRY 2016. [DOI: 10.1007/978-3-319-31849-3_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|