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Enrique CGG, Medel-Plaza M, Correa JJA, Sarnago H, Acero J, Burdio JM, Lucía Ó, Esteban J, Gómez-Barrena E. Biofilm on total joint replacement materials can be reduced through electromagnetic induction heating using a portable device. J Orthop Surg Res 2024; 19:304. [PMID: 38769535 PMCID: PMC11103973 DOI: 10.1186/s13018-024-04785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Periprosthetic joint infection is a serious complication following joint replacement. The development of bacterial biofilms bestows antibiotic resistance and restricts treatment via implant retention surgery. Electromagnetic induction heating is a novel technique for antibacterial treatment of metallic surfaces that has demonstrated in-vitro efficacy. Previous studies have always employed stationary, non-portable devices. This study aims to assess the in-vitro efficacy of induction-heating disinfection of metallic surfaces using a new Portable Disinfection System based on Induction Heating. METHODS Mature biofilms of three bacterial species: S. epidermidis ATCC 35,984, S. aureus ATCC 25,923, E. coli ATCC 25,922, were grown on 18 × 2 mm cylindrical coupons of Titanium-Aluminium-Vanadium (Ti6Al4V) or Cobalt-chromium-molybdenum (CoCrMo) alloys. Study intervention was induction-heating of the coupon surface up to 70ºC for 210s, performed using the Portable Disinfection System (PDSIH). Temperature was monitored using thermographic imaging. For each bacterial strain and each metallic alloy, experiments and controls were conducted in triplicate. Bacterial load was quantified through scraping and drop plate techniques. Data were evaluated using non-parametric Mann-Whitney U test for 2 group comparison. Statistical significance was fixed at p ≤ 0.05. RESULTS All bacterial strains showed a statistically significant reduction of CFU per surface area in both materials. Bacterial load reduction amounted to 0.507 and 0.602 Log10 CFU/mL for S. aureus on Ti6Al4V and CoCrMo respectively, 5.937 and 3.500 Log10 CFU/mL for E. coli, and 1.222 and 0.372 Log10 CFU/mL for S. epidermidis. CONCLUSIONS Electromagnetic induction heating using PDSIH is efficacious to reduce mature biofilms of S aureus, E coli and S epidermidis growing on metallic surfaces of Ti6Al4V and CoCrMo alloys.
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Affiliation(s)
- Cordero García-Galán Enrique
- Dept. of Orthopaedic Surgery and Traumatology. Hospital, Universitario Príncipe de Asturias, Av Principal de la Universidad s/n, Alcalá de Henares, Madrid, 28805, Spain.
| | - Marina Medel-Plaza
- Dept. of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM. Av. Reyes Católicos 2, Madrid, 28040, Spain
| | - John Jairo Aguilera Correa
- Dept. of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM. Av. Reyes Católicos 2, Madrid, 28040, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Héctor Sarnago
- Department of Electronic Engineering and Communications, I3A, Universidad de Zaragoza, Zaragoza, Aragon, Spain
| | - Jesús Acero
- Department of Electronic Engineering and Communications, I3A, Universidad de Zaragoza, Zaragoza, Aragon, Spain
| | - José M Burdio
- Department of Electronic Engineering and Communications, I3A, Universidad de Zaragoza, Zaragoza, Aragon, Spain
| | - Óscar Lucía
- Department of Electronic Engineering and Communications, I3A, Universidad de Zaragoza, Zaragoza, Aragon, Spain
| | - Jaime Esteban
- Dept. of Clinical Microbiology, IIS-Fundacion Jimenez Diaz, UAM. Av. Reyes Católicos 2, Madrid, 28040, Spain
- CIBERINFEC-CIBER de Enfermedades Infecciosas, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, Madrid, 28029, Spain
| | - Enrique Gómez-Barrena
- Dept of Orthopaedic Surgery and Traumatology, Hospital La Paz- IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
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Aljaafari HAS, Abdulwahhab NI, Nuxoll E. Antibiotic Augmentation of Thermal Eradication of Staphylococcus epidermidis Biofilm Infections. Pathogens 2024; 13:327. [PMID: 38668282 PMCID: PMC11054983 DOI: 10.3390/pathogens13040327] [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: 03/01/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
Staphylococcus epidermidis is a major contributor to bacterial infections on medical implants, currently treated by surgical removal of the device and the surrounding infected tissue at considerable morbidity and expense. In situ hyperthermia is being investigated as a non-invasive means of mitigating these bacterial biofilm infections, but minimizing damage to the surrounding tissue requires augmenting the thermal shock with other approaches such as antibiotics and discerning the minimum shock required to eliminate the biofilm. S. epidermidis biofilms were systematically shocked at a variety of temperatures (50-80 °C) and durations (1-10 min) to characterize their thermal susceptibility and compare it to other common nosocomial pathogens such as Staphylococcus aureus and Pseudomonas aeruginosa. Biofilms were also exposed to three classes of antibiotics (ciprofloxacin, tobramycin and erythromycin) separately at concentrations ranging from 0 to 128 μg mL-1 to evaluate their impact on the efficacy of thermal shock and the subsequent potential regrowth of the biofilm. S. epidermidis biofilms were shown to be more thermally susceptible to hyperthermia than other common bacterial pathogens. All three antibiotics substantially decreased the duration and/or temperature needed to eliminate the biofilms, though this augmentation did not meet the criteria of synergism immediately following thermal shock. Subsequent reincubation, however, revealed strong synergism on a longer timescale.
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Affiliation(s)
- Haydar A. S. Aljaafari
- Department of Chemical and Biochemical Engineering, University of Iowa, Iowa City, IA 52242, USA; (H.A.S.A.); (N.I.A.)
- Department of Chemical Engineering, University of Technology, Baghdad 10066, Iraq
| | - Nadia I. Abdulwahhab
- Department of Chemical and Biochemical Engineering, University of Iowa, Iowa City, IA 52242, USA; (H.A.S.A.); (N.I.A.)
- Department of Applied Sciences, University of Technology, Baghdad 10066, Iraq
| | - Eric Nuxoll
- Department of Chemical and Biochemical Engineering, University of Iowa, Iowa City, IA 52242, USA; (H.A.S.A.); (N.I.A.)
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Rahmati E, Khoshtaghaza MH, Banakar A, Ebadi MT, Hamidi-Esfahani Z. Continuous decontamination of cumin seed by non-contact induction heating technology: Assessment of microbial load and quality changes. Heliyon 2024; 10:e25504. [PMID: 38384505 PMCID: PMC10878883 DOI: 10.1016/j.heliyon.2024.e25504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
Over the past few decades, the demand for high-quality food has increased steadily. Therefore, it is essential to develop innovative technologies that effectively reduce microbial load while minimizing any negative effect on the quality of spices. The objective of this study was to determine the efficacy of a self-designed non-contact induction heating system using contaminated cumin seeds. The non-contact induction heating decontamination process was performed at different temperatures of 115, 135 and 155°C and durations (45, 60 and 75 s) through continuous process (screw conveyor) in Pyrex cylinder chamber. Various parameters including microbial load, color characteristics, essential oil content, surface morphology, sample temperature, and energy consumption were analyzed as dependent variables in the study. The results showed that the treatment combination (155°C - 60 s) reduced the aerobic plate count from 6.21 to 2.97 CFU/g. Mold, yeast and coliforms in the treatment combination (155°C-45 s) were also reduced by 3.26 and 3.6 CFU/g, respectively. The total color difference of the samples increased due to the degradation and alteration of pigments at high temperatures. However, no statistically significant disparity in essential oil content was observed between the treatment groups and the control group. The quantities of essential oil components in the cumin seeds were determined to align with the ISO standard, with the primary constituents identified as follows: Terpinen-7-al γ (38.98%), Cumin aldehyde (20.75%), γ-Terpinene (18.81%), β-Pinene (13.66%), and p-Cymene (6.2%). In summary, non-contact induction heating system shows promise as an effective technology for surface decontamination of spices. The acquired findings contribute to a deeper understanding of the impact of the induction heating process on both the microbial contamination levels and the quality attributes of cumin seeds. This scientific knowledge serves as a foundational framework for the prospective adoption and integration of this technology on a larger industrial scale.
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Affiliation(s)
- Edris Rahmati
- Department of Biosystems Engineering, Tarbiat Modares University, Tehran, Iran
| | | | - Ahmad Banakar
- Department of Biosystems Engineering, Tarbiat Modares University, Tehran, Iran
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Kwan JC, Flannagan RS, Vásquez Peña M, Heinrichs DE, Holdsworth DW, Gillies ER. Induction Heating Triggers Antibiotic Release and Synergistic Bacterial Killing on Polymer-Coated Titanium Surfaces. Adv Healthc Mater 2023; 12:e2202807. [PMID: 37053473 DOI: 10.1002/adhm.202202807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 03/30/2023] [Indexed: 04/15/2023]
Abstract
Infection is a major complication associated with orthopedic implants. It often involves the development of biofilms on metal substrates, which act as barriers to the host's immune system and systemic antibiotic treatment. The current standard of treatment is revision surgery, often involving the delivery of antibiotics through incorporation into bone cements. However, these materials exhibit sub-optimal antibiotic release kinetics and revision surgeries have drawbacks of high cost and recovery time. Herein, a new approach is presented using induction heating of a metal substrate, combined with an antibiotic-loaded poly(ester amide) coating undergoing a glass transition just above physiological temperature to enable thermally triggered antibiotic release. At normal physiological temperature, the coating provides a rifampicin depot for >100 days, while heating of the coating accelerates drug release, with >20% release over a 1-h induction heating cycle. Induction heating or antibiotic-loaded coating alone each reduce Staphylococcus aureus (S. aureus) viability and biofilm formation on Ti, but the combination causes synergistic killing of S. aureus as measured by crystal violet staining, determination of bacterial viability (>99.9% reduction), and fluorescence microscopy of bacteria on surfaces. Overall, these materials provide a promising platform enabling externally triggered antibiotic release to prevent and/or treat bacterial colonization of implants.
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Affiliation(s)
- Jan C Kwan
- School of Biomedical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
- Bone and Joint Institute, The University of Western Ontario, The Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, Ontario, N6G 2V4, Canada
| | - Ronald S Flannagan
- Department of Microbiology and Immunology, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5C1, Canada
| | - Mónica Vásquez Peña
- School of Biomedical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
- Bone and Joint Institute, The University of Western Ontario, The Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, Ontario, N6G 2V4, Canada
| | - David E Heinrichs
- Department of Microbiology and Immunology, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5C1, Canada
| | - David W Holdsworth
- School of Biomedical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
- Bone and Joint Institute, The University of Western Ontario, The Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, Ontario, N6G 2V4, Canada
- Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 2B8, Canada
- Department of Medical Biophysics, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5C1, Canada
| | - Elizabeth R Gillies
- School of Biomedical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
- Bone and Joint Institute, The University of Western Ontario, The Sandy Kirkley Centre for Musculoskeletal Research, University Hospital B6-200, London, Ontario, N6G 2V4, Canada
- Department of Chemistry, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B7, Canada
- Department of Chemical and Biochemical Engineering, The University of Western Ontario, 1151 Richmond Street, London, Ontario, N6A 5B9, Canada
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Pijls BG, Sanders IMJG, Kuijper EJ, Nelissen RGHH. Effectiveness of mechanical cleaning, antibiotics, and induction heating on eradication of Staphylococcus aureus in mature biofilms. Bone Joint Res 2022; 11:629-638. [PMID: 36047617 PMCID: PMC9533241 DOI: 10.1302/2046-3758.119.bjr-2022-0010.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Here we used a mature seven-day biofilm model of Staphylococcus aureus, exposed to antibiotics up to an additional seven days, to establish the effectiveness of either mechanical cleaning or antibiotics or non-contact induction heating, and which combinations could eradicate S. aureus in mature biofilms. Methods Mature biofilms of S. aureus (ATCC 29213) were grown on titanium alloy (Ti6Al4V) coupons for seven days and were subjected to the following treatments or their combinations: antibiotics, mechanical cleaning, or heat shock by induction heating of 60°C for one minute. Experiments were repeated at least five times. Results In the untreated biofilm, growth up to 1.8×1011 colony-forming units (CFU)/cm2 was observed. Treatment with ciprofloxacin, flucloxacillin, vancomycin, cefuroxime, and amoxicillin all with rifampicin gave 6.0 log, 6.1 log, 1.4 log, 4.8 log, and 3.6 log reduction in CFU/cm2, respectively. Mechanical cleaning alone resulted in 4.9 log reduction and induction heating in 7.3 log reduction. There was an additional effect of ciprofloxacin, flucloxacillin, and induction heating when used in combinations. There was no additional effect for mechanical cleaning. No bacterial growth could be detected after induction heating followed by seven days of ciprofloxacin with rifampicin. Conclusion Mechanical cleaning, antibiotics, and non-contact induction heating reduced the bacterial load of mature S. aureus biofilms with approximately 5 log or more as a single treatment. The effect of mechanical cleaning on mature S. aureus biofilms was limited when used in combination with antibiotics and/or induction heating. Cite this article: Bone Joint Res 2022;11(9):629–638.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M J G Sanders
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Prasad B, Shaikh S, Saini R, Wang Q, Zadoo S, Sadaphal V, Greenberg DE, Chopra R. Quantifying the relationship between biofilm reduction and thermal tissue damage on metal implants exposed to alternating magnetic fields. Int J Hyperthermia 2022; 39:713-724. [DOI: 10.1080/02656736.2022.2065038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bibin Prasad
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Sumbul Shaikh
- Department of Research Administration, Children’s Medical Center of Dallas, Dallas, TX, USA
| | - Reshu Saini
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Qi Wang
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Serena Zadoo
- Department of Internal Medicine, Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Varun Sadaphal
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - David E. Greenberg
- Department of Internal Medicine, Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, Dallas, TX, USA
- Department of Microbiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rajiv Chopra
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, USA
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7
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Affiliation(s)
- Shao-Ting Jerry Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK.,Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Pijls BG, Sanders IMJG, Kuijper EJ, Nelissen RGHH. Synergy between induction heating, antibiotics, and N-acetylcysteine eradicates Staphylococcus aureus from biofilm. Int J Hyperthermia 2020; 37:130-136. [PMID: 31986930 DOI: 10.1080/02656736.2019.1710269] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Non-contact induction heating (NCIH) is a noninvasive treatment modality that can be used to cause thermal damage to bacterial biofilms on a metal implant surface in the context of a prosthetic joint infection. The purpose of this study was (1) to determine the effectiveness of NCIH on killing Staphylococcus aureus from biofilm and (2) to determine the possible synergistic effect of NCIH and cocktails of antibiotics and N-acetylcysteine (NAC).Methods: Staphylococcus aureus biofilms were grown on titanium alloy (Ti6Al4V) coupons. These coupons were heated to 50 °C, 60 °C, 70 °C, 80 °C, and 90 °C for 3.5 min and subsequently exposed to cocktails of vancomycin, rifampicin and NAC at clinically relevant concentrations over 24 h.Results: In the control group without induction heating, 2.2*107 colony forming units (CFU)/cm2 were observed. At 50 °C, 60 °C, 70 °C, 80 °C, and 90 °C, a reduction of 0.3-log, 3.9-log, 4.2-log, 4.3-log, and 6.6-log CFU/cm2 were observed, respectively. There was synergy between antibiotics and induction heating that resulted in less than 100 CFU/cm2 remaining after 3.5 min at 60 °C, and exposure to vancomycin and rifampicin. Total eradication was observed at 80 °C. Total eradication was also observed at 60 °C and a cocktail of antibiotics with NAC.Conclusion: Induction heating of titanium alloy coupons is effective for the reduction of bacterial load in vitro in S. aureus biofilms. Induction heating and cocktails of antibiotics and NAC have a synergistic effect that results in the total eradication of the biofilm at 60 °C and higher for clinically relevant concentrations of vancomycin, rifampicin and NAC.
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Affiliation(s)
- Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M J G Sanders
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- S-T Jerry Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, and Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - A Hamish R W Simpson
- Department of Orthopaedic Surgery, University of Edinburgh, and Department of Trauma and Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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Abstract
Aims Induction heating is a noninvasive, nonantibiotic treatment modality that can potentially be used to cause thermal damage to the bacterial biofilm on the metal implant surface. The purpose of this study was to determine the effectiveness of induction heating on killing Staphylococcus epidermidis from biofilm and to determine the possible synergistic effect of induction heating and antibiotics. Methods S. epidermidis biofilms were grown on titanium alloy (Ti6Al4V) coupons for 24 hours (young biofilm) and seven days (mature biofilm). These coupons with biofilm were heated to temperatures of 50°C, 55°C, 60°C, 65°C, 70°C, 80°C, and 90°C for 3.5 minutes and subsequently exposed to vancomycin and rifampicin at clinically relevant concentrations. Results For the young biofilm, total eradication was observed at 65°C or higher for 3.5 minutes followed by 24 hours of vancomycin 10 mg/l and rifampicin 1 mg/l. For the mature biofilm, total eradication was observed at 60°C for 3.5 minutes followed by 24 hours of vancomycin 10 mg/l and rifampicin 1 mg/l. Total eradication was also observed at 60°C for 3.5 minutes followed by 24 hours of vancomycin 1 mg/l and rifampicin 1 mg/l followed by another thermal shock of 60°C for 3.5 minutes (two thermal shocks). Conclusion Induction heating of Ti6Al4V coupons is effective in reducing bacterial load in vitro for S. epidermidis biofilms. Induction heating and antibiotics have a synergistic effect resulting in total eradication of the biofilm at 60°C or higher for clinically relevant concentrations of vancomycin and rifampicin. Cite this article:Bone Joint Res. 2020;9(4):192–199.
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Affiliation(s)
- Bart G Pijls
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ed J Kujiper
- Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Objectives Prosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty. Non-contact induction heating of metal implants is a new and emerging treatment for PJI. However, there may be concerns for potential tissue necrosis. It is thought that segmental induction heating can be used to control the thermal dose and to limit collateral thermal injury to the bone and surrounding tissues. The purpose of this study was to determine the thermal dose, for commonly used metal implants in orthopaedic surgery, at various distances from the heating centre (HC). Methods Commonly used metal orthopaedic implants (hip stem, intramedullary nail, and locking compression plate (LCP)) were heated segmentally using an induction heater. The thermal dose was expressed in cumulative equivalent minutes at 43°C (CEM43) and measured with a thermal camera at several different distances from the HC. A value of 16 CEM43 was used as the threshold for thermal damage in bone. Results Despite high thermal doses at the HC (7161 CEM43 to 66 640 CEM43), the thermal dose at various distances from the HC was lower than 16 CEM43 for the hip stem and nail. For the fracture plate without corresponding metal screws, doses higher than 16 CEM43 were measured up to 5 mm from the HC. Conclusion Segmental induction heating concentrates the thermal dose at the targeted metal implant areas and minimizes collateral thermal injury by using the non-heated metal as a heat sink. Implant type and geometry are important factors to consider, as they influence dissipation of heat and associated collateral thermal injury. Cite this article: B. G. Pijls, I. M. J. G. Sanders, E. J. Kuijper, R. G. H. H. Nelissen. Segmental induction heating of orthopaedic metal implants. Bone Joint Res 2018;7:609–619. DOI: 10.1302/2046-3758.711.BJR-2018-0080.R1.
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Affiliation(s)
- B G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - I M J G Sanders
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - E J Kuijper
- Department of Medical Microbiology, Section Experimental Bacteriology, Leiden University Medical Center, Leiden, The Netherlands
| | - R G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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Shin T, Lim D, Kim YS, Kim SC, Jo WL, Lim YW. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018; 7:357-361. [PMID: 29922456 PMCID: PMC5987684 DOI: 10.1302/2046-3758.75.bjr-2017-0222.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Laser-engineered net shaping (LENS) of coated surfaces can overcome the limitations of conventional coating technologies. We compared the in vitro biological response with a titanium plasma spray (TPS)-coated titanium alloy (Ti6Al4V) surface with that of a Ti6Al4V surface coated with titanium using direct metal fabrication (DMF) with 3D printing technologies. Methods The in vitro ability of human osteoblasts to adhere to TPS-coated Ti6Al4V was compared with DMF-coating. Scanning electron microscopy (SEM) was used to assess the structure and morphology of the surfaces. Biological and morphological responses to human osteoblast cell lines were then examined by measuring cell proliferation, alkaline phosphatase activity, actin filaments, and RUNX2 gene expression. Results Morphological assessment of the cells after six hours of incubation using SEM showed that the TPS- and DMF-coated surfaces were largely covered with lamellipodia from the osteoblasts. Cell adhesion appeared similar in both groups. The differences in the rates of cell proliferation and alkaline phosphatase activities were not statistically significant. Conclusions The DMF coating applied using metal 3D printing is similar to the TPS coating, which is the most common coating process used for bone ingrowth. The DMF method provided an acceptable surface structure and a viable biological surface. Moreover, this method is automatable and less complex than plasma spraying. Cite this article: T. Shin, D. Lim, Y. S. Kim, S. C. Kim, W. L. Jo, Y. W. Lim. The biological response to laser-aided direct metal-coated Titanium alloy (Ti6Al4V). Bone Joint Res 2018;7:357–361. DOI: 10.1302/2046-3758.75.BJR-2017-0222.R1.
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Affiliation(s)
- T Shin
- Department of Mechanical Engineering, Sejoing University; Corentec, Central R&D Center, Seoul, South Korea
| | - D Lim
- Department of Mechanical Engineering, Sejoing University, Seoul, South Korea
| | - Y S Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S C Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - W L Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y W Lim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, South Korea
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Cheng B, Chatzinoff Y, Szczepanski D, Bing C, Shaikh S, Wyman O, Perry CE, Richardson JA, Burns DK, Evers BM, Greenberg DE, Chopra R. Remote acoustic sensing as a safety mechanism during exposure of metal implants to alternating magnetic fields. PLoS One 2018; 13:e0197380. [PMID: 29746579 PMCID: PMC5944992 DOI: 10.1371/journal.pone.0197380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/01/2018] [Indexed: 01/24/2023] Open
Abstract
Treatment of prosthetic joint infections often involves multiple surgeries and prolonged antibiotic administration, resulting in a significant burden to patients and the healthcare system. We are exploring a non-invasive method to eradicate biofilm on metal implants utilizing high-frequency alternating magnetic fields (AMF) which can achieve surface induction heating. Although proof-of-concept studies demonstrate the ability of AMF to eradicate biofilm in vitro, there is a legitimate safety concern related to the potential for thermal damage to surrounding tissues when considering heating implanted metal objects. The goal of this study was to explore the feasibility of detecting acoustic emissions associated with boiling at the interface between a metal implant and surrounding soft tissue as a wireless safety sensing mechanism. Acoustic emissions generated during in vitro and in vivo AMF exposures were captured with a hydrophone, and the relationship with surface temperature analyzed. The effect of AMF exposure power, surrounding media composition, implant location within the AMF transmitter, and implant geometry on acoustic detection during AMF therapy was also evaluated. Acoustic emissions were reliably identified in both tissue-mimicking phantom and mouse studies, and their onset coincided with the implant temperature reaching the boiling threshold. The viscosity of the surrounding medium did not impact the production of acoustic emissions; however, emissions were not present when the medium was oil due to the higher boiling point. Results of simulations and in vivo studies suggest that short-duration, high-power AMF exposures combined with acoustic sensing can be used to minimize the amount of thermal damage in surrounding tissues. These studies support the hypothesis that detection of boiling associated acoustic emissions at a metal/tissue interface could serve as a real-time, wireless safety indicator during AMF treatment of biofilm on metallic implants.
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Affiliation(s)
- Bingbing Cheng
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
- * E-mail:
| | - Yonatan Chatzinoff
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Debby Szczepanski
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Chenchen Bing
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Sumbul Shaikh
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Omar Wyman
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Cameron E. Perry
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX, United States of America
- Department of Pathology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - James A. Richardson
- Department of Pathology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Dennis K. Burns
- Department of Pathology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Bret M. Evers
- Department of Pathology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - David E. Greenberg
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas TX, United States of America
- Department of Microbiology, UT Southwestern Medical Center, Dallas TX, United States of America
| | - Rajiv Chopra
- Department of Radiology, UT Southwestern Medical Center, Dallas TX, United States of America
- Advanced Imaging Research Center, UT Southwestern Medical Center, Dallas, TX, United States of America
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Tarabichi M, Shohat N, Goswami K, Parvizi J. Can next generation sequencing play a role in detecting pathogens in synovial fluid? Bone Joint J 2018; 100-B:127-133. [DOI: 10.1302/0301-620x.100b2.bjj-2017-0531.r2] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The diagnosis of periprosthetic joint infection can be difficult due to the high rate of culture-negative infections. The aim of this study was to assess the use of next-generation sequencing for detecting organisms in synovial fluid. Materials and Methods In this prospective, single-blinded study, 86 anonymized samples of synovial fluid were obtained from patients undergoing aspiration of the hip or knee as part of the investigation of a periprosthetic infection. A panel of synovial fluid tests, including levels of C-reactive protein, human neutrophil elastase, total neutrophil count, alpha-defensin, and culture were performed prior to next-generation sequencing. Results Of these 86 samples, 30 were alpha-defensin-positive and culture-positive (Group I), 24 were alpha-defensin-positive and culture-negative (Group II) and 32 were alpha-defensin-negative and culture-negative (Group III). Next-generation sequencing was concordant with 25 results for Group I. In four of these, it detected antibiotic resistant bacteria whereas culture did not. In another four samples with relatively low levels of inflammatory biomarkers, culture was positive but next-generation sequencing was negative. A total of ten samples had a positive next-generation sequencing result and a negative culture. In five of these, alpha-defensin was positive and the levels of inflammatory markers were high. In the other five, alpha-defensin was negative and the levels of inflammatory markers were low. While next-generation sequencing detected several organisms in each sample, in most samples with a higher probability of infection, there was a predominant organism present, while in those presumed not to be infected, many organisms were identified with no predominant organism. Conclusion Pathogens causing periprosthetic infection in both culture-positive and culture-negative samples of synovial fluid could be identified by next-generation sequencing. Cite this article: Bone Joint J 2018;100-B:127–33.
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Affiliation(s)
- M. Tarabichi
- The Rothman Institute at Thomas Jefferson
University, 125 South 9th Street, Suite
1000, Philadelphia PA 19107, USA
| | - N. Shohat
- The Rothman Institute at Thomas Jefferson
University, 125 South 9th Street, Suite
1000, Philadelphia PA 19107, USA
and Tel Aviv University, Tel Aviv, Israel
| | - K. Goswami
- The Rothman Institute at Thomas Jefferson
University, 125 South 9th Street, Suite
1000, Philadelphia PA 19107, USA
| | - J. Parvizi
- The Rothman Institute at Thomas Jefferson
University, 125 South 9th Street, Suite
1000, Philadelphia PA 19107, USA
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