Skip to main content
SpringerLink
Log in

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

  • Symposium: Nanoscience in Musculoskeletal Medicine
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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 × 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.

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–B
Fig. 3
Fig. 4A–C
Fig. 5A–B

Similar content being viewed by others

References

  1. Aktekin CN, Ozturk AM, Tabak AY, Altay M, Korkusuz F. A different perspective for radiological evaluation of experimental osteomyelitis. Skeletal Radiol. 2007;36:945–950.

    Article  PubMed  Google Scholar 

  2. Alt V, Bitschnau A, Osterling J, Sewing A, Meyer C, Kraus R, Meissner SA, Wenisch S, Domann E, Schnettler R. The effects of combined gentamicin-hydroxyapatite coating for cementless joint prostheses on the reduction of infection rates in a rabbit infection prophylaxis model. Biomaterials. 2006;27:4627–4634.

    Article  PubMed  CAS  Google Scholar 

  3. Bai X, More K, Rouleau CM, Rabiei A. Functionally graded hydroxyapatite coatings doped with antibacterial components. Acta Biomater. 2010;6:2264–2273.

    Article  PubMed  CAS  Google Scholar 

  4. Bosetti M, Masse A, Tobin E, Cannas M. Silver coated materials for external fixation devices: in vitro biocompatibility and genotoxicity. Biomaterials. 2002;23:887–892.

    Article  PubMed  CAS  Google Scholar 

  5. Chen W, Liu Y, Courtney HS, Bettenga M, Agrawal CM, Bumgardner JD, Ong JL. In vitro antibacterial and biological properties of magnetron co-sputtered silver-containing hydroxyapatite coating. Biomaterials. 2006;27:5512–5517.

    Article  PubMed  CAS  Google Scholar 

  6. Chen W, Oh S, Ong AP, Oh N, Liu Y, Courtney HS, Appleford M, Ong JL. Antibacterial and osteogenic properties hydroxyapatite coatings produced using of silver-containing a sol gel process. J Biomed Mater Res A. 2007;82:899–906.

    PubMed  CAS  Google Scholar 

  7. Chen Y, Zheng X, Xie Y, Ding C, Ruan H, Fan C. Anti-bacterial and cytotoxic properties of plasma sprayed silver-containing HA coatings. J Mater Sci Mater Med. 2008;19:3603–3609.

    Article  PubMed  CAS  Google Scholar 

  8. Collinet-Adler S, Castro CA, Ledonio CG, Bechtold JE, Tsukayama DT. Acinetobacter baumannii is not associated with osteomyelitis in a rat model: a pilot study. Clin Orthop Relat Res. 2011;469:274–282.

    Article  PubMed  Google Scholar 

  9. Darouiche RO. Anti-infective efficacy of silver-coated medical prostheses. Clin Infect Dis. 1999;29:1371–1377.

    Article  PubMed  CAS  Google Scholar 

  10. Darouiche RO. Treatment of infections associated with surgical implants. N Engl J Med. 2004;350:1422–1429.

    Article  PubMed  CAS  Google Scholar 

  11. Darouiche RO, Mansouri MD, Zakarevicz D, Alsharif A, Landon GC. In vivo efficacy of antimicrobial-coated devices. J Bone Joint Surg Am. 2007;89:792–797.

    Article  PubMed  Google Scholar 

  12. Darouiche RO, Raad II, Bodey GP, Musher DM. Antibiotic susceptibility of staphylococcal isolates from patients with vascular catheter-related bacteremia: potential role of the combination of minocycline and rifampin. Int J Antimicrob Agents. 1995;6:31–36.

    Article  PubMed  CAS  Google Scholar 

  13. Garvin KL, Hanssen AD. Current concepts review: infection after total hip arthroplasty. J Bone Joint Surg Am. 1995;77:1576–1588.

    PubMed  CAS  Google Scholar 

  14. Gosheger G, Hardes J, Ahrens H, Streitburger A, Buerger H, Erren M, Gunsel A, Kemper FH, Winkelmann W, Von Eiff C. Silver-coated megaendoprostheses in a rabbit model—an analysis of the infection rate and toxicological side effects. Biomaterials. 2004;25:5547–5556.

    Article  PubMed  CAS  Google Scholar 

  15. Gristina G, Costerton JW. Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am. 1984;15:517–535.

    PubMed  CAS  Google Scholar 

  16. Grunlan JC, Choi JK, Lin A. Antimicrobial behavior of polyelectrolyte multilayer films containing cetrimide and silver. Biomacromolecules. 2005;6:1149–1153.

    Article  PubMed  CAS  Google Scholar 

  17. Hardes J, Ahrens H, Gebert C, Streitbuerger A, Buerger H, Erren M, Gunsel A, Wedemeyer C, Saxler G, Winkelmann W, Gosheger G. Lack of toxicological side-effects in silver coated megaprostheses in humans. Biomaterials. 2007;28:2869–2875.

    Article  PubMed  CAS  Google Scholar 

  18. Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ. Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection. Biomaterials. 2004;25:545–556.

    Article  PubMed  CAS  Google Scholar 

  19. Isiklar ZU, Darouiche RO, Landon GC, Beck T. Efficacy of antibiotics alone for orthopaedic device related infections. Clin Orthop Relat Res. 1996;332:184–189.

    Article  PubMed  Google Scholar 

  20. Jung WK, Koo HC, Kim KW, Shin S, Kim SH, Park YH. Antibacterial activity and mechanism of action of the silver ion in Staphylococcus aureus and Escherichia coli. Appl Environ Microbiol. 2008;74:2171–2178.

    Article  PubMed  CAS  Google Scholar 

  21. Leeuwenburgh S, Wolke J, Schoonman J, Jansen JA. Influence of deposition parameters on chemical properties of calcium phosphate coatings prepared by using electrostatic spray deposition. J Biomed Mater Res A. 2005;74:275–284.

    PubMed  CAS  Google Scholar 

  22. Nasser S. Prevention and treatment of sepsis in total hip replacement surgery. Orthop Clin North Am. 1992;23:265–277.

    PubMed  CAS  Google Scholar 

  23. Noda I, Miyaji F, Ando Y, Miyamoto H, Shimazaki T, Yonekura Y, Miyazaki M, Mawatari M, Hotokebuchi T. Development of novel thermal sprayed antibacterial coating and evaluation of release properties of silver ions. J Biomed Mater Res B Appl Biomater. 2009;89:456–465.

    PubMed  Google Scholar 

  24. Peterson JJ. Postoperative infection. Radiol Clin North Am. 2006;44:439–450.

    Article  PubMed  Google Scholar 

  25. Petty W, Spanier S, Shuster JJ, Silverthorne C. The influence of skeletal implants on incidence of infection: experiment in a canine model. J Bone Joint Surg Am. 1985;67;1236–1244.

    PubMed  CAS  Google Scholar 

  26. Sculco TP. The economic impact of infected joint arthroplasty. Orthopedics. 1995;18:871–873.

    PubMed  CAS  Google Scholar 

  27. Song WH, Ryu HS, Hong SH. Antibacterial properties of Ag (or Pt)-containing calcium phosphate coating formed by micro-arc oxidation. J Biomed Mater Res A. 2009;88:246–254.

    PubMed  Google Scholar 

  28. Taniguchi I, Schoonman J. Electrostatic spray deposition of perovskite-type oxide thin films with porous microstructure. J Mater Synth Process. 2002;10:267–275.

    Article  CAS  Google Scholar 

  29. Thian ES, Li X, Huang J, Edirisinghe MJ, Bonfield W, Best SM. Electrospray deposition of nanohydroxyapatite coatings: a strategy to mimic bone apatite mineral. Thin Solid Films. 2011;519:2328–2331.

    Article  CAS  Google Scholar 

  30. Vik H, Andersen KJ, Julshamn K, Todnem K. Neuropathy caused by silver absorption from arthroplasty cement. Lancet. 1985;1:872.

    Article  PubMed  CAS  Google Scholar 

  31. Vogely HC, Oosterbos CJ, Puts EW, Nijhof MW, Nikkels PG, Fleer A, Tonino AJ, Dhert WJ, Verbout AJ. Effects of hydroxyapatite coating on Ti-6A1-4V implant-site infection in a rabbit tibial model. J Orthop Res. 2000;18:485–493.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Ulukan Inan MD and Sinan Seber MD of the Department of Orthopaedics and Traumatology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey, for help in designing the study and interpreting our results. We also thank Cengiz Bayçu PhD and Dilek Burukoglu PhD for help with the histopathologic analysis and Summani Demirci DVM from our institutional animal laboratory for help with our efforts and in caring for the animals during the research period.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Medical Faculty, Osmangazi University, Meselik, 26480, Eskisehir, Turkey

    Nusret Kose MD & Ali Otuzbir MD

  2. Department of Materials Science and Engineering, Anadolu University, Eskisehir, Turkey

    Ceren Pekşen PhD & Aydın Doğan PhD

  3. Department of Microbiology, Medical Faculty, Osmangazi University, Meselik, 26480, Eskisehir, Turkey

    Abdurrahman Kiremitçi MD

Authors
  1. Nusret Kose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ali Otuzbir MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ceren Pekşen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdurrahman Kiremitçi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aydın Doğan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nusret Kose MD.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Osmangazi University, Eskisehir, Turkey.

About this article

Cite this article

Kose, N., Otuzbir, A., Pekşen, C. et al. A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance. Clin Orthop Relat Res 471, 2532–2539 (2013). https://doi.org/10.1007/s11999-013-2894-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-013-2894-x

Keywords

Search

Navigation