Gentamicin coating of plasma chemical oxidized titanium alloy prevents implant-related osteomyelitis in rats.
Implant related infection is one of the most feared and devastating complication associated with the use of orthopaedic implant devices. Development of anti-infective surfaces is the main strategy to prevent implant contamination, biofilm formation and implant related osteomyelitis. A second concern in orthopaedics is insufficient osseointegration of uncemented implant devices. Recently, we reported on a macroporous titanium-oxide surface (bioactive TiOB) which increases osseointegration and implant fixation. To combine enhanced osseointegration and antibacterial function, the TiOB surfaces were, in addition, modified with a gentamicin coating. A rat osteomyelitis model with bilateral placement of titanium alloy implants was employed to analyse the prophylactic effect of gentamicin-sodiumdodecylsulfate (SDS) and gentamicin-tannic acid coatings in vivo. 20 rats were randomly assigned to four groups: (A) titanium alloy; PBS inoculum (negative control), (B) titanium alloy, Staphylococcus aureus inoculum (positive control), (C) bioactive TiOB with gentamicin-SDS and (D) bioactive TiOB plus gentamicin-tannic acid coating. Contamination of implants, bacterial load of bone powder and radiographic as well as histological signs of implant-related osteomyelitis were evaluated after four weeks. Gentamicin-SDS coating prevented implant contamination in 10 of 10 tibiae and gentamicin-tannic acid coating in 9 of 10 tibiae (infection prophylaxis rate 100% and 90% of cases, respectively). In Group (D) one implant showed colonisation of bacteria (swab of entry point and roll-out test positive for S. aureus). The interobserver reliability showed no difference in the histologic and radiographic osteomyelitis scores. In both gentamicin coated groups, a significant reduction of the histological osteomyelitis score (geometric mean values: C = 0.111 ± 0.023; D = 0.056 ± 0.006) compared to the positive control group (B: 0.244 ± 0.015; p < 0.05) was observed. The radiographic osteomyelitis scores confirmed these histological findings.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena 07747, Germany. Electronic address: mdiefenbeck@hotmail.com.
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M
Diefenbeck
Innovent Technology Development, Prüssingstraße 27 B, 07745 Jena, Germany.
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C
Schrader
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena 07747, Germany.
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F
Gras
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Erlanger Allee 101, Jena 07747, Germany.
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T
Mückley
Innovent Technology Development, Prüssingstraße 27 B, 07745 Jena, Germany.
J
J
Schmidt
Chair of Materials Science, Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany.
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Zankovych
Chair of Materials Science, Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany.
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J
Bossert
Chair of Materials Science, Otto Schott Institute of Materials Research (OSIM), Faculty of Physics and Astronomy, Friedrich Schiller University Jena, Löbdergraben 32, 07743 Jena, Germany; Excellence Graduate School "Jena School for Microbial Communication (JSMC)", Friedrich Schiller University Jena, Neugasse 23, 07743 Jena, Germany.
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KD
Jandt
Department of Conservative Dentistry and Periodontology, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.
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A
Völpel
Department of Conservative Dentistry and Periodontology, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.
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BW
Sigusch
Institute of Experimental Animal Science and Animal Protection, University Hospital Jena, Dornburger Straße 23, 07743 Jena, Germany.
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H
Schubert
Institute of Experimental Animal Science and Animal Protection, University Hospital Jena, Dornburger Straße 23, 07743 Jena, Germany.
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S
Bischoff
Institut for Medical Microbiology, Universitätsklinikum Jena, Erlanger Allee 101, 07747 Jena, Germany.
W
W
Pfister
Institut for Medical Microbiology, Universitätsklinikum Jena, Erlanger Allee 101, 07747 Jena, Germany.
B
B
Edel
Königsee Implantate GmbH, OT Aschau - Am Sand 4, 07426 Allendorf, Germany.
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M
Faucon
Königsee Implantate GmbH, OT Aschau - Am Sand 4, 07426 Allendorf, Germany.
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U
Finger
D000497:Alloys / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001842:Bone and Bones / Q000473:pathology; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D005839:Gentamicins / Q000627:therapeutic use*; D008297:Male; D016348:Osseointegration; D010019:Osteomyelitis / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D019736:Prostheses and Implants / Q000009:adverse effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D013203:Staphylococcal Infections / Q000209:etiology / Q000473:pathology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects; D014025:Titanium / Q000627:therapeutic use*
D000497:Alloys; D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D005839:Gentamicins; C009495:titanium dioxide; D014025:Titanium
Animal model; Gentamicin coating; Implant-related infection; Plasma chemical oxidation; SDS; Tannic acid; Titanium alloys