Orthopedic Applications of Silver and Silver Nanoparticles
Silver (Ag) has been known for its antimicrobial properties for centuries but has received renewed interest in recent years primarily due to the rise of antibiotic-resistance and the development of Ag nanoparticles (AgNPs). In orthopedics, multiple applications containing Ag are being developed including Ag dressings, Ag-coated prosthetic implants, and Ag-based bone cements. In this chapter, we review the antimicrobial mechanisms as well as the delivery and metabolic pathways of Ag and the primary uses of Ag and AgNPs in orthopedic applications, focusing on their antimicrobial activity, toxicity, and clinical uses.
KeywordsNanotechnology Nanoparticle Silver Antimicrobial Infection Bacteria Toxicity Nanotoxicity Clinical use Antibiotic resistance Megaprosthese Bone cement In vitro In vivo
We acknowledge financial support from AO Foundation (Project S-13-15L was supported by the AO Foundation), Osteosynthesis & Trauma Care Foundation, the West Virginia National Aeronautics and Space Administration Experimental Program to Stimulate Competitive Research (WV NASA EPSCoR), NIH Grant P20GM103434, and the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 2U54GM104942-02. This work was also supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Peer Reviewed Medical Research Program, Discovery Award under Award No. W81XWH-17-1-0603. Opinions, interpretations, conclusions, and recommendations are those of the authors and are not necessarily endorsed by the funding agencies. We thank Suzanne Danley for proofreading.
- 2.Li B, Webster TJ. Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections. J Orthop Res 2017. https://doi.org/10.1002/jor.23656.Google Scholar
- 8.National Collaborating Centre for Ws, Children’s H. National Institute for Health and Clinical Excellence: guidance. Surgical site infection: prevention and treatment of surgical site infection. London: RCOG Press National Collaborating Centre for Women’s and Children’s Health; 2008.Google Scholar
- 13.Bourdillon KA, Delury CP, Cullen BM. Biofilms and delayed healing—an in vitro evaluation of silver- and iodine-containing dressings and their effect on bacterial and human cells. Int Wound J 2017. https://doi.org/10.1111/iwj.12761.Google Scholar
- 26.Springer BD, Beaver WB, Griffin WL, Mason JB, Odum SM. Role of surgical dressings in total joint arthroplasty: a randomized controlled trial. Am J Orthop (Belle Mead NJ). 2015;44(9):415–20.Google Scholar
- 31.Fries CA, Ayalew Y, Penn-Barwell JG, Porter K, Jeffery SL, Midwinter MJ. Prospective randomised controlled trial of nanocrystalline silver dressing versus plain gauze as the initial post-debridement management of military wounds on wound microbiology and healing. Injury. 2014;45(7):1111–6.CrossRefPubMedGoogle Scholar
- 45.Hardes J, Streitburger A, Ahrens H, Nusselt T, Gebert C, Winkelmann W, Battmann A, Gosheger G. The influence of elementary silver versus titanium on osteoblasts behaviour in vitro using human osteosarcoma cell lines. Sarcoma. 2007;2007:26539. PMCID:PMC1920591CrossRefPubMedPubMedCentralGoogle Scholar
- 50.Glehr M, Leithner A, Friesenbichler J, Goessler W, Avian A, Andreou D, Maurer-Ertl W, Windhager R, Tunn PU. Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J. 2013;95-b(7):988–92.CrossRefPubMedGoogle Scholar
- 54.Spadaro JA, Webster DA, Becker RO. Silver polymethyl methacrylate antibacterial bone cement. Clin Orthop Relat Res. 1979;(143):266–70.Google Scholar
- 55.Dueland R, Spadaro JA, Rahn BA. Silver antibacterial bone cement. Comparison with gentamicin in experimental osteomyelitis. Clin Orthop Relat Res. 1982;169:264–8.Google Scholar