Accessible Agent-Fatty Acid Coatings of Titanium Prostheses for Local Prevention and Treatment of Anti-Microbial Infections
Journal of Surgery
Volume 6, Issue 6, December 2018, Pages: 146-153
Received: Aug. 9, 2018; Accepted: Aug. 23, 2018; Published: Nov. 7, 2018
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Klemens Vertesich, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
Thomas Mayrhofer, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
Reinhard Windhager, Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
Klaus-Dieter Kühn, Department of Orthopaedics and Trauma Surgery, Medical University of Graz, Graz, Austria
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Prosthetic joint infection represents a major issue in arthroplasty. Local anti-infective treatment is not established in cementless prosthetic surgery. The aim of this study was to perform simulate a perioperative application of agent-fatty acid complexes on surfaces of primary and revision prosthetic material. Further, it was aimed to investigate the efficacy of these coatings by in vitro microbiological tests. Coating of cemetless titanium prostheses with gentamicin-palmitate and octenidine-laurate was performed by using a spray gun system. Coating with vancomycin eluted in trilaurin was performed by dipping of the prostheses in the solution. The prostheses were incubated in phosphate buffered saline for 7 days. Microbiological testing was performed with inhibition areolae testing for S. aureus, S. epidermidis, MRSA and C. albicans. Coating of prosthetic material was reliable and reproducible with two different techniques, dipping and spraying. The surface-concentrations of agents have reached 195μg/cm2 for gentamicin, 460μg/cm2 for octenidine and 323μg/cm2 for vancomycin. Agents inhibited S. epidermidis and S. aureus growth for seven days, C. albicans for three days and MRSA for two days. Agent-fatty acid coatings used in this study represent a biodegradable layer with good biocompatibility and comparable anti-infective efficacy as in cemented surgery due to the use of established agents, even if low concentrations are used. Modular and individual anti-infective coating was reproducibly and reliably performed by dipping coating, which may represent a potential perioperative coating approach.
Anti-Infective Coating, Biodegradable Coating, Prosthetic Joint Infection, Gentamicin, Vancomycin, Octenidine
To cite this article
Klemens Vertesich, Thomas Mayrhofer, Reinhard Windhager, Klaus-Dieter Kühn, Accessible Agent-Fatty Acid Coatings of Titanium Prostheses for Local Prevention and Treatment of Anti-Microbial Infections, Journal of Surgery. Vol. 6, No. 6, 2018, pp. 146-153. doi: 10.11648/j.js.20180606.11
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Dale H, Hallan G, Hallan G, Espehaug B, Havelin LI, Engesaeter LB. 2009. Increasing risk of revision due to deep infection after hip arthroplasty. Acta Orthop. 80: 639-645.
Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. 2010. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 468: 52-56.
Dy CJ, Marx RG, Bozic KJ, Pan TJ, Padgett DE, Lyman S. 2014. Risk factors for revision within 10 years of total knee arthroplasty. Clin Orthop Relat Res. 472: 1198-1207.
Parvizi J, Pawasarat IM, Azzam KA, Joshi A, Hansen EN, Bozic KJ. 2010. Periprosthetic joint infection: the economic impact of methicillin-resistant infections. J Arthroplasty. 25: 103-107.
Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. 2009. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 91: 128-133.
Gristina AG. 1987. Biomaterial-centered infection: microbial adhesion versus tissue integration. Science (New York, N. Y.). 237: 1588-1595.
Agricola R, Heijboer MP, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Waarsing JH. 2013. Cam impingement causes osteoarthritis of the hip: a nationwide prospective cohort study (CHECK). Ann Rheum Dis. 72: 918-923.
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. 2008. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 466: 1710-1715.
Zimmerli W. 2014. Clinical presentation and treatment of orthopaedic implant-associated infection. J Intern Med. 276: 111-119.
Trampuz A, Zimmerli W. 2005. Prosthetic joint infections: update in diagnosis and treatment. Swiss Med Wkly. 135: 243-251.
Zimmerli W, Moser C. 2012. Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol. 65: 158-168.
Fogelberg EV, Zitzmann EK, Stinchfield FE. 1970. Prophylactic penicillin in orthopaedic surgery. J Bone Joint Surg Am. 52: 95-98.
An YH, Bradley J, Powers DL, Friedman RJ. 1997. The prevention of prosthetic infection using a cross-linked albumin coating in a rabbit model. Journal of Bone and Joint Surgery-British Volume. 79b: 816-819.
Buchholz HW, Elson RA, Heinert K. 1984. Antibiotic-loaded acrylic cement: current concepts. Clin Orthop Relat Res. 96-108.
Parvizi J, Saleh KJ, Ragland PS, Pour AE, Mont MA. 2008. Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop. 79: 335-341.
Gallo J, Holinka M, Moucha CS. 2014. Antibacterial surface treatment for orthopaedic implants. Int J Mol Sci. 15: 13849-13880.
Stallard CP, McDonnell KA, Onayemi OD, O'Gara JP, Dowling DP. 2012. Evaluation of protein adsorption on atmospheric plasma deposited coatings exhibiting superhydrophilic to superhydrophobic properties. Biointerphases. 7: 31.
Gao A, Hang R, Huang X, Zhao L, Zhang X, Wang L, et al. 2014. The effects of titania nanotubes with embedded silver oxide nanoparticles on bacteria and osteoblasts. Biomaterials. 35: 4223-4235.
Heidenau F, Mittelmeier W, Detsch R, Haenle M, Stenzel F, Ziegler G, et al. 2005. A novel antibacterial titania coating: metal ion toxicity and in vitro surface colonization. J Mater Sci Mater Med. 16: 883-888.
Lemire JA, Harrison JJ, Turner RJ. 2013. Antimicrobial activity of metals: mechanisms, molecular targets and applications. Nat Rev Microbiol. 11: 371-384.
Akiyama T, Miyamoto H, Yonekura Y, Tsukamoto M, Ando Y, Noda I, et al. 2013. Silver oxide-containing hydroxyapatite coating has in vivo antibacterial activity in the rat tibia. J Orthop Res. 31: 1195-1200.
Tsuchiya H, Shirai T, Nishida H, Murakami H, Kabata T, Yamamoto N, et al. 2012. Innovative antimicrobial coating of titanium implants with iodine. J Orthop Sci. 17: 595-604.
Shirai T, Tsuchiya H, Nishida H, Yamamoto N, Watanabe K, Nakase J, et al. 2014. Antimicrobial megaprostheses supported with iodine. J Biomater Appl. 29: 617-623.
Matl FD, Obermeier A, Repmann S, Friess W, Stemberger A, Kuehn KD. 2008. New anti-infective coatings of medical implants. Antimicrob Agents Chemother. 52: 1957-1963.
Kuehn K-D. 2010. Part 1: In-vitro release of gentamicinpalmitate coating in uncemented titanium implants. International Journal of Nano and Biomaterials. 3: 94 - 106.
Kuehn K-D, Brunke J. 2010. Part 2: Effectiveness of a novel gentamicinpalmitate coating on biofilm formation of Staphylococcus aureus and Staphylococcus epidermidis. International Journal of Nano and Biomaterials. 3.
Kittinger C, Marth E, Windhager R, Weinberg AM, Zarfel G, Baumert R, et al. 2011. Antimicrobial activity of gentamicin palmitate against high concentrations of Staphylococcus aureus. J Mater Sci Mater Med. 22: 1447-1453.
Folsch C, Federmann M, Kuehn KD, Kittinger C, Kogler S, Zarfel G, et al. 2015. Coating with a novel gentamicinpalmitate formulation prevents implant-associated osteomyelitis induced by methicillin-susceptible Staphylococcus aureus in a rat model. Int Orthop. 39: 981-988.
Folsch C, Federmann M, Lakemeier S, Kuehn KD, Kittinger C, Kerwat M, et al. 2016. Systemic antibiotic therapy does not significantly improve outcome in a rat model of implant-associated osteomyelitis induced by Methicillin susceptible Staphylococcus aureus. Arch Orthop Trauma Surg. 136: 585-592.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. 2007. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 89: 780-785.
Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. 2012. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 27: 61-65 e61.
Harris LG, Tosatti S, Wieland M, Textor M, Richards RG. 2004. Staphylococcus aureus adhesion to titanium oxide surfaces coated with non-functionalized and peptide-functionalized poly (L-lysine)-grafted-poly (ethylene glycol) copolymers. Biomaterials. 25: 4135-4148.
Fielding GA, Roy M, Bandyopadhyay A, Bose S. 2012. Antibacterial and biological characteristics of silver containing and strontium doped plasma sprayed hydroxyapatite coatings. Acta Biomater. 8: 3144-3152.
Noda I, Miyaji F, Ando Y, Miyamoto H, Shimazaki T, Yonekura Y, et al. 2009. Development of novel thermal sprayed antibacterial coating and evaluation of release properties of silver ions. J Biomed Mater Res B Appl Biomater. 89: 456-465.
Obermeier A, Matl FD, Schwabe J, Zimmermann A, Kuhn KD, Lakemeier S, et al. 2012. Novel fatty acid gentamicin salts as slow-release drug carrier systems for anti-infective protection of vascular biomaterials. J Mater Sci Mater Med. 23: 1675-1683.
Brohede U, Forsgren J, Roos S, Mihranyan A, Engqvist H, Stromme M. 2009. Multifunctional implant coatings providing possibilities for fast antibiotics loading with subsequent slow release. J Mater Sci Mater Med. 20: 1859-1867.
Reynolds PE. 1989. Structure, biochemistry and mechanism of action of glycopeptide antibiotics. Eur J Clin Microbiol Infect Dis. 8: 943-950.
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