Does vitamin E-blended UHMWPE prevent biofilm formation?
BACKGROUND
Biofilm-related periprosthetic infections are catastrophic to patients and clinicians. Data suggest the addition of vitamin E to UHMWPE may have the ability to reduce biofilm formation on the surface of UHMWPE; however, previous studies were performed using stagnant broth solutions that may not have simulated a physiologic environment. In addition, the observed differences in levels of bacterial attachment, though statistically significant, may not be clinically significant.


OBJECTIVE
We blended vitamin E with UHMWPE material and tested it for the ability to resist biofilm formation using a clinical isolate of methicillin-resistant Staphylococcus aureus (MRSA). Three additional materials were tested for comparison: highly crosslinked UHMWPE, compression-molded UHMWPE, and polyetheretherketone. We also determined whether the surface roughness of these materials facilitated biofilm formation.


METHODS
Using a flow cell system, samples of each material type were placed into separate chambers. A 10% solution of brain-heart infusion broth containing 10(5) colony-forming units (CFUs)/mL was flowed through the flow cell over 48 hours. The number of bacteria that adhered to the surface was quantified and biofilm formation was observed qualitatively using scanning electron microscopy. Optical profilometry was used to determine the surface roughness of each material type.


RESULTS
Vitamin E-blended UHMWPE did not reduce biofilm formation of a clinically relevant strain of MRSA compared to materials that did not have vitamin E. More specifically, vitamin E-blended materials had similar amounts of biofilm formation (~ 8 log10 CFUs/cm(2)) compared to materials not containing vitamin E (~ 8.1 log10 CFUs/cm(2)) (p > 0.4). The roughness of vitamin E-blended material surfaces (mean ± SD: 1.85 ± 0.46 µm) compared to that of materials without vitamin E (2.06 ± 1.24 µm) did not appear to influence biofilm formation.


CONCLUSIONS
Under physiologically relevant conditions, vitamin E-blended UHMWPE did not have the ability to reduce the formation of biofilms by MRSA.


CONCLUSIONS
These data indicate that the addition of vitamin E to UHMWPE may not reduce clinically relevant rates of biofilm-related periprosthetic infections of total joint arthroplasty devices.
Bone and Joint Research Laboratory 151F, George E. Wahlen Department of Veterans Affairs, 500 Foothill Drive, Salt Lake City, UT, 84148, USA, roy.bloebaum@hsc.utah.edu.
Dustin L
DL
Williams
John
J
Vinciguerra
Julia M
JM
Lerdahl
Roy D
RD
Bloebaum
D001672:Biocompatible Materials; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D008422:Materials Testing; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects* / Q000254:growth & development; D011095:Polyethylenes / Q000737:chemistry*; D016459:Prosthesis-Related Infections / Q000188:drug therapy / Q000517:prevention & control*; D014810:Vitamin E / Q000737:chemistry* / Q000494:pharmacology / Q000627:therapeutic use
D001672:Biocompatible Materials; D011095:Polyethylenes; C111601:ultra-high molecular weight polyethylene; D014810:Vitamin E