JOURNAL ARTICLE

A silver ion-doped calcium phosphate-based ceramic nanopowder-coated prosthesis increased infection resistance

Nusret Kose, Ali Otuzbir, Ceren Pekşen, Abdurrahman Kiremitçi, Aydin Doğan
Clinical Orthopaedics and related Research 2013, 471 (8): 2532-9
23463287

BACKGROUND: Despite progress in surgical techniques, 1% to 2% of joint arthroplasties become complicated by infection. Coating implant surfaces with antimicrobial agents have been attempted to prevent initial bacterial adhesion to implants with varying success rates. We developed a silver ion-containing calcium phosphate-based ceramic nanopowder coating to provide antibacterial activity for orthopaedic implants.

QUESTIONS/PURPOSES: We asked whether titanium prostheses coated with this nanopowder would show resistance to bacterial colonization as compared with uncoated prostheses.

METHODS: We inserted titanium implants (uncoated [n = 9], hydroxyapatite-coated [n = 9], silver-coated [n = 9]) simulating knee prostheses into 27 rabbits' knees. Before implantation, 5 × 10(2) colony-forming units of Staphylococcus aureus were inoculated into the femoral canal. Radiology, microbiology, and histology findings were quantified at Week 6 to define the infection, microbiologically by increased rate of implant colonization/positive cultures, histologically by leukocyte infiltration, necrosis, foreign-body granuloma, and devitalized bone, and radiographically by periosteal reaction, osteolysis, or sequestrum formation.

RESULTS: Swab samples taken from medullary canals and implants revealed a lower proportion of positive culture in silver-coated implants (one of nine) than in uncoated (eight of nine) or hydroxyapatite-coated (five of nine) implants. Silver-coated implants also had a lower rate of colonization. No cellular inflammation or foreign-body granuloma was observed around the silver-coated prostheses.

CONCLUSIONS: Silver ion-doped ceramic nanopowder coating of titanium implants led to an increase in resistance to bacterial colonization compared to uncoated implants.

CLINICAL RELEVANCE: Silver-coated orthopaedic implants may be useful for resistance to local infection but will require in vivo confirmation.

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