Artikel
Novel anti-bacterial silver loaded biopolymer implant coating activated by extracorporal shockwave – an in vivo proof-of-concept study
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Autoren
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Martin Schulze
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Manfred Fobker
- Universitätsklinikum Münster, Zentrum für Laboratoriumsmedizin, Münster, Germany
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Fintan Moriarty
- AO Research Institute Davos, Davos, Switzerland
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Stephan Zeiter
- AO Research Institute Davos, Davos, Switzerland
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James Tapia-Dean
- AO Research Institute Davos, Davos, Switzerland
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Julian Hasselmann
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Marco Chittò
- AO Research Institute Davos, Davos, Switzerland
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Melanie Nonhoff
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Silke Niemann
- Universitätsklinikum Münster, Institut für Medizinische Mikrobiologie, Münster, Germany
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Christoph Theil
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Georg Gosheger
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
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Jan Pützler
- Universitätsklinikum Münster, Klinik für Allgemeine Orthopädie und Tumororthopädie, Münster, Germany
| Veröffentlicht: | 23. Oktober 2023 |
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Gliederung
Text
Objectives: The risk of periprosthetic joint infection (PJI) increases with increasing surface area, with an incidence of to 20% in mega endoprostheses, increasing up to 40% after multiple revisions [1].
At present, few implant coatings with anti-infective properties are in clinical use. Silver-related adverse effects have been reported in some cases [2].
A novel, cytocompatible biopolymer implant coating loaded with silver ions was designed and tested in vitro [3]. The current work evaluates in vivo efficacy of the biopolymer coating in a mouse implant-related infection model compared with uncoated controls.
Methods: Forty female mice aged 14–20 weeks were included in four randomized groups of n=10.
In each mouse, two pretreated titanium discs were implanted into subcutaneous pouches and inoculated with 10E6 CFU Staphylococcus epidermidis (RP62A).
Group 1 serves as control, the implants are uncoated. In group 2, the implants are coated with the silver ion-loaded biopolymer. The coating in intervention group 3 is the same and a transcutaneous intervention with extracorporeal shock wave is performed. In group 4, the coating is supplemented by a second layer, which elutes antibiotics.
After three days of infection quantitative microbiology was performed on rinsing fluid, sonicated implants, and surrounding soft tissue. Rinsing was performed directly after explantation in 12-Well plates with 1ml PBS and followed by sonication.
Laboratory chemical analyses were performed to determine the concentration of released anti-infectives. To evaluate the systemic response, the level of C-reactive protein in plasma was measured by ELISA at four time points.
Results and conclusion: To date, two mice each of the control group and the novel coating were tested. No complications were observed in any of the animals tested. Compared with the uncoated control group, a 10- to 100-fold lower bacterial load of 2.40E2 – 4.58E3 was found after sonication and rinsing, and of 2.48E4 – 5.33E4 in soft tissue in the coated group 2 (Figure).
The in vivo results to this point confirm the previous in vitro results and indicate an antibacterial activity of the new silver-loaded biopolymer coating. Remainder of the group are currently underway. This novel coating could be an effective measure in the prophylaxis of PJI.
References
- 1.
- Theil C, Röder J, Gosheger G, Deventer N, Dieckmann R, Schorn D, Hardes J, Andreou D. What is the Likelihood That Tumor Endoprostheses Will Experience a Second Complication After First Revision in Patients With Primary Malignant Bone Tumors And What Are Potential Risk Factors? Clin Orthop Relat Res. 2019 Dec;477(12):2705-14. DOI: 10.1097/CORR.0000000000000955
- 2.
- Fiore M, Sambri A, Zucchini R, Giannini C, Donati DM, De Paolis M. Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery. Eur J Orthop Surg Traumatol. 2021 Feb;31(2):201-220. DOI: 10.1007/s00590-020-02779-z
- 3.
- Schulze M, Fobker M, Puetzler J, Hillebrand J, Niemann S, Schulte E, Kurzynski J, Gosheger G, Hasselmann J. Mechanical and microbiological testing concept for activatable anti-infective biopolymer implant coatings. Biomater Adv. 2022 Jul;138:212917. DOI: 10.1016/j.bioadv.2022.212917
