title: A silver ion-doped calcium phosphate-based ceramic nanopowder-coated prosthesis increased infection resistance.
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.
  
  
  OBJECTIVE
  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 × 10(2) 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.
  
  
  CONCLUSIONS
  Silver-coated orthopaedic implants may be useful for resistance to local infection but will require in vivo confirmation.
authors: Department of Orthopaedics and Traumatology, Medical Faculty, Osmangazi University, Meselik, 26480, Eskisehir, Turkey. nkose@ogu.edu.tr
authors: Nusret
authors: N
authors: Kose
authors: Ali
authors: A
authors: Otuzbir
authors: Ceren
authors: C
authors: Pekşen
authors: Abdurrahman
authors: A
authors: Kiremitçi
authors: Aydin
authors: A
authors: Doğan
mesh_terms: D000497:Alloys; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000295:instrumentation*; D002130:Calcium Phosphates / Q000737:chemistry*; D020099:Coated Materials, Biocompatible; D003692:Delayed-Action Preparations; D004195:Disease Models, Animal; D017886:Durapatite / Q000737:chemistry*; D007720:Knee Prosthesis / Q000009:adverse effects; D050997:Nanomedicine; D053758:Nanoparticles; D011208:Powders; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D011817:Rabbits; D011859:Radiography; D012834:Silver / Q000008:administration & dosage*; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development; D013997:Time Factors; D014025:Titanium / Q000737:chemistry
chemical_list: D000497:Alloys; D000900:Anti-Bacterial Agents; D002130:Calcium Phosphates; D020099:Coated Materials, Biocompatible; D003692:Delayed-Action Preparations; D011208:Powders; C031462:titanium alloy (TiAl6V4); D012834:Silver; D017886:Durapatite; C020243:calcium phosphate; D014025:Titanium