Abstract
Periprosthetic infections are an eminent factor in patient care and also having significant economic implications. The number of biofilm-infection related replacement surgeries is increasing and will continue to do so in the following decades. To reduce both the health burden of the patients and the costs to the healthcare sector, new solutions for implant materials resistant to such infections are necessary. This study researches different surface modifications of cobalt–chromium–molybdenum (CoCrMo) based implant materials and their influence on the development of biofilms. Three smooth surfaces (CoCrMo, CoCrMo TiN, and CoCrMo polished) and three rough surfaces (CoCrMo porous coated, CoCrMo cpTi, and CoCrMo TCP) are compared. The most common infectious agents in periprosthetic infections are Staphylococcus aureus and Coagulase-negative staphylococci (e.g., Staphylococcus epidermidis), therefore strains of these two species have been chosen as model organisms. Biofilms were grown on material disks for 48 h and cell number, polysaccharide content, and protein contend of the biofilms were measured. Additionally, regulation of genes involved in early biofilm development (S. aureus icaA, icaC, fnbA, fnbB, clfB, atl; S. epidermidis atlE, aap) was detected using RT-q-PCR. All results were compared to the base alloy without modifications. The results show a correlation between the surface roughness and the protein and polysaccharide content of biofilm structures and also the gene expression of the biofilms grown on the different surface modifications. This is supported by the significantly different protein and polysaccharide contents of the biofilms associated with rough and smooth surface types. Additionally, early phase biofilm genes (particularly icaA, icaC, and aap) are statistically significantly downregulated compared to the control at 48 h on rough surfaces. CoCrMo TiN and polished CoCrMo were the two smooth surface modifications which performed best on the basis of low biofilm content.
Highlights
Due to a general increase in life expectancy, improved surgical techniques and medical care, the demand for implants has increased greatly over recent decades
S. aureus Newman has already been used for many studies on biofilm formation (e.g., Johnson et al, 2008; Abraham and Jefferson, 2012; Forson et al, 2020; Inés Molina et al, 2020; Pinto et al, 2020) it is not considered a very good biofilm forming strain and the same is true for the ica negative S. epidermidis strain (e.g., Stepanovic et al, 2000; Lee et al, 2016; Paduszynska et al, 2019; Di Pilato et al, 2020; Paulitsch-Fuchs et al, 2021)
The variant of the S. aureus strain used in this study S. aureus Newman D2C is considered to be a relatively good biofilm forming strain (Grundmeier et al, 2004; Tsompanidou et al, 2010; Abraham and Jefferson, 2012; Dauros-Singorenko et al, 2020; Paulitsch-Fuchs et al, 2021)
Summary
Due to a general increase in life expectancy, improved surgical techniques and medical care, the demand for implants (e.g., joint replacement prosthesis) has increased greatly over recent decades. Periprosthetic infections have an incidence of approximately 1–4% after primary TKA (Phillips et al, 2006). The incidence rate for a periprosthetic infection following a TKA replacement has been reported to be approximately 0.5% after 1 year, 0.8% after 5 years, and 1.4% after years (Tsaras et al, 2012), with cost per patient associated with TKA replacement of up to ~30,000 USD (Palsis et al, 2018). Those periprosthetic infections can be caused by a number of different organisms, most of which are bacteria. Quorum sensing (Kavanaugh and Horswill, 2016; Kim et al, 2017), higher mutation frequencies (Ryder et al, 2012), and dormant cells (Venter et al, 2017; Lamret et al, 2020; Shoji and Chen, 2020) contribute to the pathogenicity of those strains
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