Clinical Orthopaedics and Related Research®

, Volume 471, Issue 8, pp 2532–2539

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance


    • Department of Orthopaedics and Traumatology, Medical FacultyOsmangazi University
  • Ali Otuzbir
    • Department of Orthopaedics and Traumatology, Medical FacultyOsmangazi University
  • Ceren Pekşen
    • Department of Materials Science and EngineeringAnadolu University
  • Abdurrahman Kiremitçi
    • Department of Microbiology, Medical FacultyOsmangazi University
  • Aydın Doğan
    • Department of Materials Science and EngineeringAnadolu University
Symposium: Nanoscience in Musculoskeletal Medicine

DOI: 10.1007/s11999-013-2894-x

Cite this article as:
Kose, N., Otuzbir, A., Pekşen, C. et al. Clin Orthop Relat Res (2013) 471: 2532. doi:10.1007/s11999-013-2894-x



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.


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


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 × 102 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.


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.


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.

Copyright information

© The Association of Bone and Joint Surgeons® 2013