Multifunctional Ti-(Ca,Zr)-(C,N,O,P) films for load-bearing implants

Synergistic antibacterial effect of graphene-coated titanium loaded with levofloxacin

In this study, graphene coating was introduced to the modified titanium surface to prevent bacterial infection in oral implants. We modified the titanium surface through SLA and silanization treatment and then coated the surface with graphene. The structure and surface properties were characterized by XPS and SEM. Graphene-coated titanium sheet was incubated with bacteria to test the antibacterial property, which was enhanced by adsorption and release of levofloxacin. We further implanted the graphene-coated titanium sheet loaded with levofloxacin into rabbits to test the antibacterial properties in vivo. The graphene coating exhibited inherent antibacterial properties through membrane stress and the generation of reactive oxygen species (ROS). When loaded with levofloxacin, the graphene coating exhibited a synergistic antibacterial effect and effectively prevented bacterial infections following the implantation. The graphene coating is promising to improve the antibacterial functions of oral implant surfaces to prevent bacterial infection.

Structural, physical, chemical, and biological surface characterization of thermomechanically treated Ti-Nb-based alloys for bone implants

Metastable near-beta Ti-21.8Nb-6Zr and Ti-19.7Nb-5.8Ta (at%) alloys were subjected to a thermomechanical treatment comprising cold rolling (CR) with a true strain of e = 0.3 and post-deformation annealing (PDA) in the 500-900°C temperature range to ensure the superelastic behavior which is important for bone implants. It was found that PDA resulted in formation of about 1-2 μm-thick oxide layer on the Ti-Nb-Zr and Ti-Nb-Ta alloy samples; the layer was mainly composed of TiO₂ , in rutile and anatase modifications. The structure, the phase and chemical compositions, and some surface-sensitive properties of the alloys were compared to those of Ti-50.7Ni and Ti-Grade2 reference materials. These surface layers (especially that of the Ti-Nb-Zr alloy) demonstrated a promising combination of high cohesion strength (load causing surface layer fracture is over 25 N), hardness (∼12 GPa), and hydrophilicity (contact angle ∼40°). Surface modification by controlled oxidation during air annealing increases corrosion resistance and enhances in vivo osteoinductive properties of Ti-Nb-Zr alloys by changing the surface microrelief, increasing the surface wettability, and improving the mechanical characteristics, thus laying the foundation for the development of medical implants with prolonged service life. So, it was confirmed that the same thermomechanical treatment, which creates conditions for the superelastic behavior of the bulk metal (CR: e = 0.3 + PDA = 500-700°C for 1 hr), would also create a strong, protective and biocompatible layer on the implant surface.

Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama

Implanted biomaterials play a key role in current success of orthopedic and trauma surgery. However, implant-related infections remain among the leading reasons for failure with high economical and social associated costs. According to the current knowledge, probably the most critical pathogenic event in the development of implant-related infection is biofilm formation, which starts immediately after bacterial adhesion on an implant and effectively protects the microorganisms from the immune system and systemic antibiotics. A rationale, modern prevention of biomaterial-associated infections should then specifically focus on inhibition of both bacterial adhesion and biofilm formation. Nonetheless, currently available prophylactic measures, although partially effective in reducing surgical site infections, are not based on the pathogenesis of biofilm-related infections and unacceptable high rates of septic complications, especially in high-risk patients and procedures, are still reported.In the last decade, several studies have investigated the ability of implant surface modifications to minimize bacterial adhesion, inhibit biofilm formation, and provide effective bacterial killing to protect implanted biomaterials, even if there still is a great discrepancy between proposed and clinically implemented strategies and a lack of a common language to evaluate them.To move a step forward towards a more systematic approach in this promising but complicated field, here we provide a detailed overview and an original classification of the various technologies under study or already in the market. We may distinguish the following: 1. Passive surface finishing/modification (PSM): passive coatings that do not release bactericidal agents to the surrounding tissues, but are aimed at preventing or reducing bacterial adhesion through surface chemistry and/or structure modifications; 2. Active surface finishing/modification (ASM): active coatings that feature pharmacologically active pre-incorporated bactericidal agents; and 3. Local carriers or coatings (LCC): local antibacterial carriers or coatings, biodegradable or not, applied at the time of the surgical procedure, immediately prior or at the same time of the implant and around it. Classifying different technologies may be useful in order to better compare different solutions, to improve the design of validation tests and, hopefully, to improve and speed up the regulatory process in this rapidly evolving field.

Antibacterial surface treatment for orthopaedic implants

It is expected that the projected increased usage of implantable devices in medicine will result in a natural rise in the number of infections related to these cases. Some patients are unable to autonomously prevent formation of biofilm on implant surfaces. Suppression of the local peri-implant immune response is an important contributory factor. Substantial avascular scar tissue encountered during revision joint replacement surgery places these cases at an especially high risk of periprosthetic joint infection. A critical pathogenic event in the process of biofilm formation is bacterial adhesion. Prevention of biomaterial-associated infections should be concurrently focused on at least two targets: inhibition of biofilm formation and minimizing local immune response suppression. Current knowledge of antimicrobial surface treatments suitable for prevention of prosthetic joint infection is reviewed. Several surface treatment modalities have been proposed. Minimizing bacterial adhesion, biofilm formation inhibition, and bactericidal approaches are discussed. The ultimate anti-infective surface should be “smart” and responsive to even the lowest bacterial load. While research in this field is promising, there appears to be a great discrepancy between proposed and clinically implemented strategies, and there is urgent need for translational science focusing on this topic.