title: Molecular engineering of an orthopaedic implant: from bench to bedside.
abstract: The use of metallic implants has revolutionised the practice of orthopaedic surgery. While the safety and biocompatibility of these devices are excellent, a small percentage becomes infected. These infections are due to the formation of a biofilm that harbours bacteria encased in a complex extracellular matrix. The matrix serves as a barrier to immune surveillance as well as limiting the biocidal effects of systemic and local antibiotics. The objective of the review is to describe a novel approach to controlling implant infection using an antibiotic that is linked to titanium through a self-assembled monolayer of siloxy amines. We show that the hybrid-engineered surface is stable, biocompatible and resists colonisation by bacterial species most commonly associated with implant-related infections. Studies with rodent bone infection models suggest that the engineered titanium surface prevents bone infection. Results of a very recent investigation utilising a sheep model of infection indicate that the titanium-tethered antibiotic controls infection without compromising bone formation and remodelling. From all of these perspectives, the tethered antibiotic holds promise of providing a novel and practical approach to reducing implant-associated infections.
authors.affiliation: Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA. irving.shapiro@jefferson.edu
authors.forename: I M
authors.initials: IM
authors.lastname: Shapiro
authors.forename: N J
authors.initials: NJ
authors.lastname: Hickok
authors.forename: J
authors.initials: J
authors.lastname: Parvizi
authors.forename: S
authors.initials: S
authors.lastname: Stewart
authors.forename: T P
authors.initials: TP
authors.lastname: Schaer
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects; D001698:Biomedical Engineering; D005109:Extracellular Matrix / Q000276:immunology / Q000382:microbiology; D006801:Humans; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods; D019736:Prostheses and Implants / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000276:immunology / Q000382:microbiology; D012756:Sheep; D012833:Siloxanes / Q000737:chemistry; D014025:Titanium / Q000009:adverse effects / Q000737:chemistry*; D014640:Vancomycin / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D012833:Siloxanes; D014640:Vancomycin; D014025:Titanium