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Sambri A, Cevolani L, Passarino V, Bortoli M, Parisi SC, Fiore M, Campanacci L, Staals E, Donati DM, De Paolis M. Mid-Term Results of Single-Stage Surgery for Patients with Chronic Osteomyelitis Using Antibiotic-Loaded Resorbable PerOssal ® Beads. Microorganisms 2023; 11:1623. [PMID: 37512796 PMCID: PMC10385580 DOI: 10.3390/microorganisms11071623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
This retrospective study reports on the treatment of chronic osteomyelitis with local debridement combined with PerOssal®. The diagnosis of chronic osteomyelitis was confirmed in all cases and classified according to the Cierny-Mader (C-M) classification. The primary outcome was the eradication of infection at a minimum of one year after surgery. A total of 93 patients (median age: 40 years) were included. The most represented sites were the femur (24, 25.8%) and tibia (52, 55.9%). Twenty-six patients (28.0%) had significant local or systemic comorbidities (C-M Class B hosts). According to anatomic type, 31 cases were type I, 13 type II, 21 type III and 28 type IV. Vancomycin was added to PerOssal® in most cases (80, 86.0%). In 24 (25.8%) cases, Vancomycin and Rifampicin were combined. In 32 (34.4%) cases, intraoperative cultures were negative. Staphylococcus aureus was isolated in 39 (63.9%) patients, and Gram-negative bacteria were isolated in 12 cases. The median follow-up was 21 months (range 12-84). A total of 21 (22.6%) patients developed an infection recurrence (IR) after a median follow-up of 11 months (range: 1-47). PerOssal® holds several practical advantages compared to other bone void fillers. Thus, due to its good biocompatibility and sufficient antibiotic release, it represents a viable adjuvant treatment in chronic osteomyelitis.
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Affiliation(s)
- Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luca Cevolani
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Valentina Passarino
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefania Claudia Parisi
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Campanacci
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Eric Staals
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Davide Maria Donati
- Orthopedic Oncology Unit, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Risk Factors for Postoperative Osteomyelitis among Patients after Bone Fracture: A Matched Case-Control Study. J Clin Med 2022; 11:jcm11206072. [PMID: 36294391 PMCID: PMC9604902 DOI: 10.3390/jcm11206072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
The healthcare burden of osteomyelitis is increasing. Postoperative and posttraumatic osteomyelitis account for 80% of all cases of osteomyelitis. The aim of this study was to find risk factors for postoperative osteomyelitis in Kazakhstan. We included 245 patients admitted to the National Scientific Center of Traumatology and Orthopedics from 2018 to 2020. Cases were matched with controls in a 1:4 ratio. Exact matching was performed by gender, ICD-10, and ICD-9 codes. The main variables included socio-demographics, diagnosis at admission, characteristics of fractures, comorbidities, complications, hospitalization milestones, and osteomyelitis characteristics. Descriptive analyses, along with bivariate analysis and multivariate conditional logistic regression, were performed. Open fracture (adjOR = 6.25; 95%CI 1.64−23.79), the presence of complications of initial fracture (adjOR = 3.46, 95%CI 1.13−10.56), comminuted fracture form (adjOR = 1.87; 95%CI 0.73−4.75), a positive history of diabetes or blood glucose >7 g/L (adjOR = 4.25; 95%CI 1.26−14.3), incision or wound length of more than 10 cm (adjOR = 6.53; 95%CI 1.1−38.6), additional implanted medical item (adjOR = 1.23; 95% CI 1.1−1.47), and unemployment or being retired (adjOR = 4.21; 95%CI 1.74−10.18) were found to be significant predictors of postoperative osteomyelitis. Almost all our findings are concordant with previous studies, except for the type of fracture. Different authors report conflicting results on the latter potential risk factor. Therefore, prospective studies on this issue are required.
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Choi SH, Jang YS, Jang JH, Bae TS, Lee SJ, Lee MH. Enhanced antibacterial activity of titanium by surface modification with polydopamine and silver for dental implant application. J Appl Biomater Funct Mater 2020; 17:2280800019847067. [PMID: 31530071 DOI: 10.1177/2280800019847067] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Biofilm formation and microbial colonization on the surface of implant devices may cause dental caries and peri-implantitis. Therefore, various surface treatments have been developed to improve the antibacterial activity of titanium implant. METHODS Silver-loaded polydopamine coating was formed by immersing pure titanium in dopamine hydrochloride/HCl buffer solution for 24 h in 50 mL silver nitrate solutions with different concentrations for 30 min. Microbial growth inhibition and microbial growth curve analyses for bacterial solutions of Streptococcus mutans and Porphyromonas gingivalis incubated with the specimens were respectively conducted by counting the numbers of colonies on agar solid medium and by measuring absorbance using enzyme-linked immunosorbent assay reader. RESULTS Silver nanoparticles were uniformly distributed over the whole surface of the polydopamine and silver-coated titanium specimens. The numbers of microbial colonies for both bacteria cultured with surface-modified titanium were significantly lower than those cultured with uncoated titanium. When Streptococcus mutans and Porphyromonas gingivalis were cultured with surface-modified titanium, the lag phase of the growth curves for both bacteria was continually maintained, whereas the lag phase for Streptococcus mutans and Porphyromonas gingivalis changed to exponential phase after 9 and 15 h, respectively, when both bacteria were cultured with uncoated titanium. CONCLUSION It was confirmed that the coating of polydopamine and silver on the surface of titanium effectively retards the microbial growth, which can cause the formation of biofilm and pathogenesis of gum disease in the mouth.
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Affiliation(s)
- Soo-Hyoen Choi
- Department of Dental Biomaterials and Institute of Biodegradable Material, Chonbuk National University, Jeollabuk-do, South Korea
| | - Yong-Seok Jang
- Department of Dental Biomaterials and Institute of Biodegradable Material, Chonbuk National University, Jeollabuk-do, South Korea
| | - Jong-Hwa Jang
- Department of Dental Hygiene, Dankook University, Jeollabuk-do, South Korea
| | - Tae-Sung Bae
- Department of Dental Biomaterials and Institute of Biodegradable Material, Chonbuk National University, Jeollabuk-do, South Korea
| | - Sook-Jeong Lee
- Department of Bioactive Material Science, Chonbuk National University, Jeonju, South Korea
| | - Min-Ho Lee
- Department of Dental Biomaterials and Institute of Biodegradable Material, Chonbuk National University, Jeollabuk-do, South Korea
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Wiesenmueller S, Cierniak P, Juebner M, Koerner E, Hegemann D, Mercer-Chalmers Bender K. Tailored antimicrobial activity and long-term cytocompatibility of plasma polymer silver nanocomposites. J Biomater Appl 2018; 33:327-339. [PMID: 30223732 DOI: 10.1177/0885328218793488] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The deposition of coatings enabling antibacterial properties in combination with cytocompatibility remains a challenge for biomaterial applications, such as in medical devices. Silver is one of the most utilized antibacterial surface components, due to its efficacy and extensive applicability. In this work, silver-containing plasma polymer nanocomposites (single layer and multilayers) were developed and tested, with a focus on cytotoxicity and bactericidal function, on the NIH3T3 mammalian cell line as well as Gram-negative ( Pseudomonas aeruginosa) and Gram-positive ( Staphylococcus aureus) bacterial strains. The data demonstrate that a tuneable Ag+ release is required, allowing sufficient antimicrobial activity while retaining appropriate cytocompatibility over the entire testing period of up to eight days.
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Affiliation(s)
- Steffi Wiesenmueller
- 1 Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Peter Cierniak
- 2 EMPA Material Science and Technology, St. Gallen, Switzerland
| | - Martin Juebner
- 3 Institute of Forensic Medicine, University of Basel, Health Department Basel-Stadt, Basel, Switzerland
| | - Enrico Koerner
- 3 Institute of Forensic Medicine, University of Basel, Health Department Basel-Stadt, Basel, Switzerland
| | - Dirk Hegemann
- 3 Institute of Forensic Medicine, University of Basel, Health Department Basel-Stadt, Basel, Switzerland
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Wagner C, Obst U, Hänsch GM. Implant-Associated Posttraumatic Osteomyelitis: Collateral Damage by Local Host Defense? Int J Artif Organs 2018; 28:1172-80. [PMID: 16353124 DOI: 10.1177/039139880502801115] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Infections following osteosynthesis or total joint replacement, also known as “implant-associated posttraumatic osteomyelitis”, represent a major complication in orthopedic and trauma surgery. While the formation of bacterial biofilms on the implanted osteosynthesis materials is generally accepted as cause of the persistent infection, the molecular mechanisms leading to the progressive and destructive local inflammatory process and eventually to bone degradation, the osteolysis, have not been delineated. Here we provide evidence supporting the hypothesis that it is not the infection per se that causes tissue degradation and osteolysis, but rather the cytotoxic, proteolytic, and proinflammatory effector functions of cells of the host defense, particularly of the infiltrating polymorphonuclear neutrophils.
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Affiliation(s)
- C Wagner
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Clinic for Traumatology and Reconstructive Surgery, Ludwigshafen, Germany
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In Vitro and In Vivo Evaluation of Tetracycline Loaded Chitosan-Gelatin Nanosphere Coatings for Titanium Surface Functionalization. Macromol Biosci 2016; 17. [DOI: 10.1002/mabi.201600130] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/02/2016] [Indexed: 11/07/2022]
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Wagner C, Hänsch G. Pathophysiologie der implantatassoziierten Infektion. DER ORTHOPADE 2015; 44:967-73. [DOI: 10.1007/s00132-015-3183-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Janković A, Eraković S, Ristoscu C, Mihailescu Serban N, Duta L, Visan A, Stan GE, Popa AC, Husanu MA, Luculescu CR, Srdić VV, Janaćković D, Mišković-Stanković V, Bleotu C, Chifiriuc MC, Mihailescu IN. Structural and biological evaluation of lignin addition to simple and silver-doped hydroxyapatite thin films synthesized by matrix-assisted pulsed laser evaporation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5333. [PMID: 25578691 DOI: 10.1007/s10856-014-5333-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/28/2014] [Indexed: 06/04/2023]
Abstract
We report on thin film deposition by matrix-assisted pulsed laser evaporation of simple hydroxyapatite (HA) or silver (Ag) doped HA combined with the natural biopolymer organosolv lignin (Lig) (Ag:HA-Lig). Solid cryogenic target of aqueous dispersions of Ag:HA-Lig composite and its counterpart without silver (HA-Lig) were prepared for evaporation using a KrF* excimer laser source. The expulsed material was assembled onto TiO2/Ti substrata or silicon wafers and subjected to physical-chemical investigations. Smooth, uniform films adherent to substratum were observed. The chemical analyses confirmed the presence of the HA components, but also evidenced traces of Ag and Lig. Deposited HA was Ca deficient, which is indicative of a film with increased solubility. Recorded X-ray Diffraction patterns were characteristic for amorphous films. Lig presence in thin films was undoubtedly proved by both X-ray Photoelectron and Fourier Transform Infra-Red Spectroscopy analyses. The microbiological evaluation showed that the newly assembled surfaces exhibited an inhibitory activity both on the initial steps of biofilm forming, and on mature bacterial and fungal biofilm development. The intensity of the anti-biofilm activity was positively influenced by the presence of the Lig and/or Ag, in the case of Staphylococcus aureus, Pseudomonas aeruginosa and Candida famata biofilms. The obtained surfaces exhibited a low cytotoxicity toward human mesenchymal stem cells, being therefore promising candidates for fabricating implantable biomaterials with increased biocompatibility and resistance to microbial colonization and further biofilm development.
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Affiliation(s)
- A Janković
- Innovation Center, Faculty of Technology and Metallurgy, University of Belgrade, 11000, Belgrade, Serbia
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Aytaç S, Schnetzke M, Swartman B, Herrmann P, Woelfl C, Heppert V, Gruetzner PA, Guehring T. Posttraumatic and postoperative osteomyelitis: surgical revision strategy with persisting fistula. Arch Orthop Trauma Surg 2014; 134:159-65. [PMID: 24337627 DOI: 10.1007/s00402-013-1907-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Posttraumatic and postoperative osteomyelitis (PPO) with bacteria colonisation during trauma and associated surgery is an increasing clinical problem. This study investigated the treatment of PPO by surgical revision including irrigation, debridement, and temporary hardware maintenance. In addition, a drainage was inserted as persisting fistula to control osteomyelitis until fracture healing was achieved. Trauma- and osteomyelitis-related factors that influenced the study outcome were determined. PATIENTS AND METHODS 67 consecutive patients with PPO were included. At onset of PPO, patients had incomplete fracture healing. Patients were subdivided by time of PPO occurrence (acute, subacute or chronic), initial soft tissue trauma, anatomical location, and initial fracture type (AO classification). The study outcome measures included radiographic and clinical follow-up. RESULTS 59 patients could be followed for an average of 23 months after revision surgery. A bone healing was achieved by 89% of patients after 14.7 ± 13.4 weeks. Fractures of the lower extremity, open fractures and comminuted C-type fractures took significantly longer to achieve bone healing (p < 0.05 each). Time of PPO occurrence did not influence bone healing. After fracture consolidation, no re-infection was found. CONCLUSIONS This study showed high rates of bone healing, indicating that this strategy with persisting fistula should be considered as alternative treatment option in patients with PPO.
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Affiliation(s)
- Sâra Aytaç
- Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Abteilung für Unfallchirurgie und Orthopädie, Ludwig Guttmann Strasse 13, 67071, Ludwigshafen am Rhein, Germany,
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Luo SH, Xiao W, Wei XJ, Jia WT, Zhang CQ, Huang WH, Jin DX, Rahaman MN, Day DE. In vitro evaluation of cytotoxicity of silver-containing borate bioactive glass. J Biomed Mater Res B Appl Biomater 2010; 95:441-8. [DOI: 10.1002/jbm.b.31735] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Torres N, Oh S, Appleford M, Dean DD, Jorgensen JH, Ong JL, Agrawal CM, Mani G. Stability of antibacterial self-assembled monolayers on hydroxyapatite. Acta Biomater 2010; 6:3242-55. [PMID: 20188873 DOI: 10.1016/j.actbio.2010.02.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 02/15/2010] [Accepted: 02/19/2010] [Indexed: 01/31/2023]
Abstract
Open fractures are common in battlefields, motor vehicle accidents, gunshot wounds, sports injuries, and high-energy falls. Such fractures are treated using hydroxyapatite (HA)-based bone graft substitutes. However, open fracture wounds are highly susceptible to bacterial infections. Hence, this study was focused on incorporating antibacterial properties to HA using silver (Ag) carrying self-assembled monolayers (SAMs). Also, the stability of Ag carrying SAMs on HA was investigated under sterilization and physiological conditions. Initially, the -COOH terminated phosphonic acid SAMs of two different chain lengths (11 carbon atoms - shorter chain and 16 carbon atoms - longer chain) were deposited on HA. Antibacterial SAMs (ASAMs) were prepared by chemically attaching Ag to shorter and longer chain SAMs coated HA. X-ray photoelectron spectroscopy, atomic force microscopy, and contact angle goniometry collectively confirmed the attachment of Ag onto SAMs coated HA. The bacterial adhesion study showed that the adherence of Staphylococcus aureus was significantly reduced on ASAMs coated HA when compared to control-HA. The stability studies showed that gas plasma, dry heat and autoclave degraded most of the ASAMs on HA. UV irradiation did not damage the shorter chain ASAMs as vigorously as other treatments, while it degraded the longer chain ASAMs completely. Ethylene oxide treatment did not degrade the longer chain ASAMs unlike all other treatments but it severely damaged the shorter chain ASAMs. Both shorter and longer chain ASAMs significantly desorbed from the HA surfaces under physiological conditions although longer chain ASAMs exhibited better stability than shorter chain ASAMs. This study demonstrated the potential for using ASAMs to provide antibacterial properties to HA and the need for developing techniques to improve stability of SAMs under sterilization and physiological conditions.
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Affiliation(s)
- Nelson Torres
- Department of Biomedical Engineering, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
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Abstract
Infections occur in 0.5-5% of cases after implantation of an endoprosthesis and represent one of the most severe complications of artificial joint replacements. Approximately 300,000 primary implantations for hip and knee prostheses are carried out in Germany annually with a corresponding number of early and late infections. This means that approximately 4,000-6,000 cases are to be expected annually. Periprosthetic infections normally lead to a significant loss of function and quality of life for patients and the complex remediation is costly. Therefore, preventive measures, such as perioperative prophylaxis with antibiotics, maintaining highly sterile conditions during operations and an expedient selection of patients are of substantial importance. The basic principles of an adequate restoration include identification of the pathogen, local eradication of the infection mostly after removal of the prosthesis, pathogen-oriented systemic and local antibiotic therapy and finally re-implantation of the revision prosthesis under infection-free conditions. The standard procedure for revision surgery is a two-phase replacement with maintenance of an infection-free interval before renewal of the prosthesis. The use of single-phase or multi-phase strategies, as well as the selection of cemented or cement-free revision, varies between centers as a definitive evaluation is not yet available.The most important parameters for successful treatment of periprosthetic infections have been identified as the earliest possible diagnosis, radical surgical cleansing with an adequate antibiotic therapy and successful restoration has been reported in approximately 80% of cases. Because of the complex therapy regime, treatment in specialized centers is generally recommended especially under the aspect of a demanding patient monitoring.
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Juan L, Zhimin Z, Anchun M, Lei L, Jingchao Z. Deposition of silver nanoparticles on titanium surface for antibacterial effect. Int J Nanomedicine 2010; 5:261-7. [PMID: 20463942 PMCID: PMC2865021 DOI: 10.2147/ijn.s8810] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Indexed: 11/23/2022] Open
Abstract
Microbial colonization on implanted devices and biofilm formation is a recurrent complication in implant surgery and may result in loss of implants. The aim of this study was to deposit silver nanoparticles on a titanium surface to obtain antibacterial properties. In the present study, we prepared a silver nanoparticle-modified titanium (Ti-nAg) surface using silanization method. The morphology and chemical components of the Ti-nAg surface were characterized by scanning electron microscopy (SEM) equipped with energy-dispersive spectroscopy (EDS). Two species of bacteria, Staphylococcus aureus and Escherichia coli, were utilized to test the antibacterial effect of the Ti-nAg treated surface. The SEM examination revealed that a small quantity of silver nanoparticles was sparsely deposited on the titanium surface. The diameter of these nanoparticles ranged from ten to several hundred nm. EDS analyses revealed that there was 4.26% of Ag present on the surface. After a 24-hour incubation, 94% of Staphylococcus aureus and over 95% of Escherichia coli had been killed on the Ti-nAg surface, and the SEM examination of anti-adhesive efficacy test showed that there were less bacteria attached to Ti-nAg surface than to a control surface of untreated Titanium. These data suggest that silver nanoparticle-modified titanium is a promising material with an antibacterial property that may be used as an implantable biomaterial.
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Affiliation(s)
- Liao Juan
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China
| | - Zhu Zhimin
- Department of Prosthodontics, West China Stomatology Hospital, Sichuan University, Chengdu 610041, PR China
| | - Mo Anchun
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China
- Department of Dental Implant, West China Stomatology Hospital, Sichuan University, Chengdu 610041, PR China
| | - Li Lei
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China
| | - Zhang Jingchao
- State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, PR China
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Microvascular response to calcium phosphate bone substitutes: an intravital microscopy analysis. Langenbecks Arch Surg 2010; 395:1147-55. [DOI: 10.1007/s00423-010-0608-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
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Mani G, Johnson DM, Marton D, Feldman MD, Patel D, Ayon AA, Agrawal CM. Drug delivery from gold and titanium surfaces using self-assembled monolayers. Biomaterials 2008; 29:4561-73. [DOI: 10.1016/j.biomaterials.2008.08.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 08/20/2008] [Indexed: 02/02/2023]
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Wagner C, Hänsch GM, Wentzensen A, Heppert V. [Implant-associated post-traumatic osteomyelitis. Bacterial biofilms and the immune defence as protagonists of the local inflammatory process]. Unfallchirurg 2007; 109:761-9. [PMID: 16924444 DOI: 10.1007/s00113-006-1089-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Formation of bacterial biofilms on implants is a severe complication following orthopaedic surgery. In the present study we addressed the role of the immune response, particularly with regard to the pathogenesis of the disease. METHODS In a prospective study comprising 74 patients with implant-associated post-traumatic osteomyelitis, peripheral blood cells as well as cells recovered from the infected site during surgery were characterised phenotypically and functionally. RESULTS We found massive infiltration of polymorphonuclear neutrophils (PMN), which were highly activated, particularly regarding their bactericidal potential, such as increased production of superoxides and upregulation of activation-associated surface receptors. CONCLUSION PMN are activated in response to the implant-associated osteomyelitis; they also infiltrate the infected tissue, but cannot control the infection. By release of their cytotoxic entities they could contribute to tissue destruction and eventually to osteolysis.
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Affiliation(s)
- C Wagner
- Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Deutschland.
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Abstract
PURPOSE To provide a comprehensive review of the management of carpal tunnel syndrome. METHODS AND RESULTS A systematic literature review is provided of the history, anatomy, pathophysiology, epidemiology, diagnostic criteria, investigative surgical techniques, results and complications for carpal tunnel syndrome. CONCLUSION Surgery for carpal tunnel syndrome requires meticulous attention to history-taking, investigation, counseling, training and surgical technique if unsatisfactory results and complications are to be avoided.
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Affiliation(s)
- J Haase
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Ewald A, Glückermann SK, Thull R, Gbureck U. Antimicrobial titanium/silver PVD coatings on titanium. Biomed Eng Online 2006; 5:22. [PMID: 16556327 PMCID: PMC1435898 DOI: 10.1186/1475-925x-5-22] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 03/24/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Biofilm formation and deep infection of endoprostheses is a recurrent complication in implant surgery. Post-operative infections may be overcome by adjusting antimicrobial properties of the implant surface prior to implantation. In this work we described the development of an antimicrobial titanium/silver hard coating via the physical vapor deposition (PVD) process. METHODS Coatings with a thickness of approximately 2 mum were deposited on titanium surfaces by simultaneous vaporisation of both metals in an inert argon atmosphere with a silver content of approximately 0.7-9% as indicated by energy dispersive X-ray analysis. On these surfaces microorganisms and eukaryotic culture cells were grown. RESULTS The coatings released sufficient silver ions (0.5-2.3 ppb) when immersed in PBS and showed significant antimicrobial potency against Staphylococcus epidermis and Klebsiella pneumoniae strains. At the same time, no cytotoxic effects of the coatings on osteoblast and epithelial cells were found. CONCLUSION Due to similar mechanical performance when compared to pure titanium, the TiAg coatings should be suitable to provide antimicrobial activity on load-bearing implant surfaces.
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Affiliation(s)
- Andrea Ewald
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Susanne K Glückermann
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Roger Thull
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
| | - Uwe Gbureck
- Department for Functional Materials in Medicine and Dentistry, University of Würzburg, Pleicherwall 2, D-97070 Würzburg, Germany
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Abstract
Minimizing the surgical approach in treating patients with spinal infections by using local antibiotic treatment and avoiding a ventral approach reduces the anesthesia and surgical risks in patients with comorbidities. In this study we used calcium sulphate pellets (OsteoSet T and the OsteoSet Bone-void Filler kit) as a delivery system for different antibiotics. Of a group of 32 patients with histologically and microbiologically diagnosed spondylitis, a cohort of 16 patients was treated by just a dorsal surgical approach in combination with a local antibiotic delivery system. Of these 16 patients, 14 patients showed a normalization of the infection parameters, no more bone loss in the spondylitic region, and a bony fusion after 6 to 9 months postoperatively. Two patients died from septic circumstances 4 and 6 weeks postoperatively. Two patients had to have one revision surgery because of a seroma; no other complications caused by the calcium sulphate pellets were observed. The use of calcium sulphate pellets as antibiotic delivery system allows a controlled local antibiotic therapy with an osteoconductive material in combination with a minimized surgical approach. Furthermore, calcium sulphate pellets have proven their reliable capability as bone void filler.
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Affiliation(s)
- Dietrich von Stechow
- Department of Orthopaedic Surgery, University Hospital Frankfurt/Main, Frankfurt am Main, Germany.
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