Frank Heidenau

An extended spectrum bactericidal titanium dioxide (TiO2) coating for metallic implants: in vitro effectiveness against MRSA and mechanical properties.

Implant infections remain feared and severe complications after total joint arthroplasty. The incidence of multi-resistant pathogens, causing such infections, is rising continuously, and orthopaedic surgeons are confronted with an ever-changing resistance pattern. Anti-infectious surface coatings aim for a high local effective concentration and a low systemic toxicity at the same time. Antibacterial efficacy and biomechanical stability of a novel broad-spectrum anti-infectious coating is assessed in the present study. Antibacterial efficacy of a sol–gel derived titanium dioxide (TiO2) coating for metal implants with and without integrated copper ions as antibiotic agent was assessed against methicillin resistant Staphylococcus aureus (MRSA 27065). Both bacterial surface adhesion and growth of planktonic bacteria were assessed with bare and various TiO2-coated Ti6Al4V metal discs. Furthermore, bonding strength of the TiO2 surface coating, using standard testing procedures, as well as surface roughness were determined. We found a significant reduction of the bacterial growth rate for the coatings with integrated copper ions, with highest reduction rates observed for a fourfold copper TiO2-coating. Pure TiO2 without integrated copper ions did not reduce bacterial growth compared to uncoated Ti6Al4V. The coating was not detached from the substrate by standard adhesive failure testing, which indicated an excellent durability of the implant coating. The TiO2 coating with integrated copper ions could offer a new strategy for preventing implant-associated infections, with antibacterial properties not only against the most common bacteria causing implant infections but also against multiresistant strains such as MRSA.

Mechanical Properties of Anti-Infectious, Bio-Active and Wear Resistant Ceramic Implant Surface Coatings

Implant failure due to aseptic loosening is a major complication in total hip arthroplasty. Different implant coatings aim to reduce the risk of implant loosening by anti-infectious, bio-active or wear resistant approaches. The mechanical properties, especially bonding strength and wear resistance, of a Cu-TiO2, CaP and TiN coating were investigated in this study. A scratch test and a standard adhesive test were used to determine the bonding strength of the coatings. To analyse the wear resistance a modified special testing machine was used to evaluate wear with PU-foam and PMMA as counterparts. The investigations showed that all coatings have greater bonding strengths than the minimum required 22 N/mm2 for medical implant coatings. Significant differences in total wear were determined during the wear tests. With the exception of the CaP no removal of the coatings was detected.

Antibacterial Effect of a 4x Cu-TiO2 Coating Simulating Acute Periprosthetic Infection—An Animal Model

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.

A biocompatible sol–gel derived titania coating for medical implants with antibacterial modification by copper integration

Implant-associated infections are dangerous complications and may cause dramatic illness with hematogeneous spread of bacteria and secondary infections. Since treatment of these infections remains most challenging and commonly requires implant removal, prevention is of utmost importance. In the present work a titania-sol was equipped with a copper salt resulting after calcination in a titania coating (TiO2) with antibacterial properties combined with good cytocompatibility. In vitro tests with bacteria as well as tissue cells were carried out under corresponding conditions. Mouse fibroblasts and different staphylococcal strains were used for growth inhibition assays with serial dilutions of CuCl2. Cultivation on the surface of bare Ti6Al4V, TiO2-coated and copper-filled TiO2-coated Ti6Al4V samples was performed with both bacteria and tissue cells. Bacterial and cellular proliferation and mitochondrial activity were hereby determined. Coating of Ti6Al4V with pure TiO2 significantly improved cytocompatibility compared to the uncoated alloy. In the growth inhibition assays, fibroblasts tolerated higher concentrations of copper ions than did bacteria. Nevertheless, copper integration reduced fibroblast proliferation and mitochondrial activity on the surface coating. On the other hand, integration of copper into the TiO2-coating significantly reduced adhesion of viable bacteria resulting in a promising combination of cytocompatibility and antibacterial properties. Additionally, significant bacterial growth inhibition by antibacterial amounts of copper was also demonstrated in the supernatant. In conclusion, the copper-loaded TiO2-coatings for medical implants may be a promising approach to reduce the rate of implant-associated infections.