Abstract
Every year, worldwide, millions of people suffering from joint pain undergo joint replacement. For most patients, joint arthroplasty reduces pain and improve function, though a small fraction will experience implant failure. One of the main reasons includes prosthetic joint infection (PJI), involving the prosthesis and adjacent tissues. Few microorganisms (MO) are required to inoculate the implant, resulting in the formation of a biofilm on its surface. Standard treatment includes not only removal of the infected prosthesis but also the elimination of necrotic bone fragments, local and/or systemic administration of antibiotics, and revision arthroplasty with a new prosthesis, immediately after the infection is cleared. Therefore, an alternative to the conventional therapeutics would be the incorporation of natural antimicrobial compounds into the prosthesis. Chitosan (Ch) is a potential valuable biomaterial presenting properties such as biocompatibility, biodegradability, low immunogenicity, wound healing ability, antimicrobial activity, and anti-inflammatory potential. Regarding its antimicrobial activity, Gram-negative and Gram-positive bacteria, as well as fungi are highly susceptible to chitosan. Calcium phosphate (CaP)-based materials are commonly utilized in orthopedic and dentistry for their excellent biocompatibility and bioactivity, particularly in the establishment of cohesive bone bonding that yields effective and rapid osteointegration. At present, the majority of CaP-based materials are synthetic, which conducts to the depletion of the natural resources of phosphorous in the future due to the extensive use of phosphate. CaP in the form of hydroxyapatite (HAp) may be extracted from natural sources as fish bones or scales, which are by-products of the fish food industry. Thus, this review aims to enlighten the fundamental characteristics of Ch and HAp biomaterials which makes them attractive to PJI prevention and bone regeneration, summarizing relevant studies with these biomaterials to the field.
Highlights
Implantation of medical devices has been growing in parallel with the constant development of medical care and it is expected that, at least once in their lifetime, all individuals will undertake some type of medical device implantation [1,2]
The outcome of a revision surgery will be extremely affected by the cause of prosthesis failure because the type of treatment differs profoundly between aseptic loosening, mechanical failure, or prosthetic joint infections (PJI)
The surgery consists in removing part or all of a damaged joint and installing hardware to allow movement without pain or limitations—an orthopedic prosthesis made of metal, plastic, ceramic, or a combination of these materials [61]
Summary
Implantation of medical devices has been growing in parallel with the constant development of medical care and it is expected that, at least once in their lifetime, all individuals will undertake some type of medical device implantation [1,2]. Joint replacement (arthroplasty) is a life-enhancing procedure for millions of people worldwide each year [3] This procedure is only considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. The outcome of a revision surgery will be extremely affected by the cause of prosthesis failure because the type of treatment differs profoundly between aseptic loosening, mechanical failure, or prosthetic joint infections (PJI). For this reason, there is an increasing trend for publications about prosthetic infection and the development of antimicrobial strategies, which was the basis for the literature survey adopted in this review. This review aims at describing the pathology of PJI, to understand the main players and to consider chitosan and hydroxyapatite as biomaterials with potential to improve this impacting health problem
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