Abstract
The purpose of our study was to investigate the antibacterial effect of a spacer (Ti6Al4V) coated with 4x Cu-TiO2 in an animal model simulating an acute periprosthetic infection by Staphylococcus aureus. Ti6Al4 bolts contaminated with Staphylococcus aureus were implanted into the femoral condyle of rabbits (n = 36) divided into 3 groups. After one week in group 1 (control) the bolts were removed without any replacement. In group2 Ti6Al4V bolts with a 4x Cu-TiO2 coating and in group 3 beads of a gentamicin-PMMA chain were imbedded into the borehole. Microbiological investigation was performed at the primary surgery, at the revision surgery and after scarification of the rabbits 3 weeks after the first surgery. Blood tests were conducted weekly. The initial overall infection rate was 88.9%. In group 2 and 3 a significant decrease of the infection rate was shown in contrast to the control group. The C-reactive protein (CRP) levels declined one week after the first surgery except in the control group where the CRP level even increased. This is the first in vivo study that demonstrated the antibacterial effects of a fourfold Cu-TiO2 coating. For the future, the coating investigated could be a promising option in the treatment of implant-associated infections.
Highlights
In most industrialized countries, the number of joint replacements has significantly increased during previous years
The history of joint replacement is generally recognized as a success story, periprosthetic infections after knee replacements still occur with an incidence of approximately 1.6% within the first 2 years with a predicted overall cost for the treatment of periprosthetic infections coming to more than $50,000 per case [2,3]
After inoculation with Staphylococcus aureus, a total of 32 out of the 36 rabbits were infected which corresponds with an overall infection rate of 88.9%
Summary
The number of joint replacements has significantly increased during previous years. The history of joint replacement is generally recognized as a success story, periprosthetic infections after knee replacements still occur with an incidence of approximately 1.6% within the first 2 years with a predicted overall cost for the treatment of periprosthetic infections coming to more than $50,000 per case [2,3]. There is still not one clear evidence based strategy for the effective treatment of periprosthetic infections, most orthopedic surgeons agree to remove the implant immediately after infection [4,5]. Staphylococci, such as Staphylococcus aureus and coagulase-negative species, cause most of the periprosthetic infections [6,7,8]. Coatings loaded with antibiotics, or with non-antibiotic organic antimicrobial agents and adhesion resistant coatings are frequently discussed [9]
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