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      Titanium-copper-nitride coated spacers for two-stage revision of infected total hip endoprostheses Translated title: Titan-Kupfer-Nitrid beschichtete Spacer für den zweizeitigen Wechsel infizierter Hüftendoprothesen

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          Abstract

          Within the first two years after total hip arthroplasty implant-associated infection has become the second most common reason for a revision surgery. Two-stage implant exchange is frequently conducted using temporary spacers made of antibiotic-loaded cement in order to prevent a bacterial colonization on the spacer. Avoiding several disadvantages of cement spacers, a conventional hemi-endoprosthesis was equipped with a copper-containing implant coating for inhibition of bacterial biofilms. In the present paper details of this novel treatment concept are presented including a case report.

          Translated abstract

          Innerhalb der ersten beiden Jahre nach endoprothetischem Hüftgelenkersatz stellt die implantat-assoziierte Infektion mittlerweile den zweithäufigsten Grund für eine Revisionsoperation dar. Beim zweizeitigen septischen Wechsel werden temporäre Platzhalter (Spacer) aus antibiotikahaltigem Zement zur Therapie und Vermeidung einer bakteriellen Besiedlung verwendet. Mit dem Ziel, bekannte Nachteile von Zementspacern zu umgehen, wurde eine Biofilm-inhibierende kupferhaltige Beschichtung auf eine konventionelle Hemi-Endoprothese aufgebracht. Im Folgenden soll das Design dieses neuartigen Therapieansatzes im Rahmen eines Fallberichts vorgestellt werden.

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          Most cited references31

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          Silver-coated megaendoprostheses in a rabbit model--an analysis of the infection rate and toxicological side effects.

          Deep infection of megaprostheses remains a serious complication in orthopedic tumor surgery. Despite the use of systemic and local antibiotic prophylaxis the reported infection rate is between 5% and 35%. Silver-coated medical devices proved their effectiveness in reducing infections. The objective of this study was to examine in vivo the antimicrobial efficacy and possible side-effects of a silver-coated megaprosthesis. In a first study, 30 rabbits (15 titanium versus 15 silver-coated Mutars-endoprostheses) were infected with Staphylococcus aureus. In a second study, toxicological side effects were analyzed in 10 rabbits with a silver-coated megaprosthesis. The silver group showed significantly (p<0.05) lower infection rates (7% versus 47%) in comparison with the titanium group. Measurements of the C-reactive-protein, neutrophilic leukocytes, rectal temperature and body weight showed significant (p<0.05) lower signs of inflammation in the silver group. The analysis of the silver concentration in blood (median 1.883ppb) and in organs (0.798-86.002ppb) showed elevated silver concentrations without pathologic changes in laboratory parameters and without histological changes of organs. In conclusion, the new silver-coated Mutars-megaprosthesis resulted in reduced infection rates without toxicological side effects, suggesting that this prosthesis might be a promising device in tumor surgery exhibiting antimicrobial activity.
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            [Depot effects of various antibiotics mixed with Palacos resins].

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              A novel antibacterial titania coating: metal ion toxicity and in vitro surface colonization.

              Postoperative implant-associated infection is still an unresolved and serious complication in modern surgery. Antibacterial and biocompatible surfaces could both reduce infection rates and promote tissue integration. In this respect, a comparative study of the antibacterial as well as the biocompatible potential of different metal ions in vitro is presented. The assays used were growth inhibition tests with different metal salts carried out with tissue cells and bacteria under corresponding culture conditions. Additionally, in vitro tests in direct surface contact with tissue cells and bacteria onto a novel copper containing sol-gel derived titanium dioxide coating (Cu-TiO2) and a fourfold Cu-TiO2 coating were performed. The values were compared to a non-filled titanium dioxide coating and standard Ti6Al4V alloy. SEM-investigations were performed to approve the results of the in vitro tests. Among Ag+, Zn2+, Co2+, Al3+ and Hg2+, the growth inhibition tests revealed an outstanding position of copper ions as antibacterial but nevertheless bio-tolerant additive. These results were affirmed by the cell tests in direct surface contact and SEM-investigations, where best cell growth was found on the Cu-TiO2 coatings. Highest antibacterial properties with a tolerable cytocompatibility could be observed on the fourfold Cu-TiO2 coatings. Consequently, surfaces with custom-tailored antibacterial properties may be established and could be of particular interest in revision and tumor arthroplasty.
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                Author and article information

                Journal
                GMS Krankenhhyg Interdiszip
                GMS Krankenhaushyg Interdiszip
                GMS Krankenhaushygiene interdisziplinär
                German Medical Science GMS Publishing House
                1863-5245
                15 December 2011
                2011
                : 6
                : 1 , Prevention and therapy of nosocomial infections
                : Doc16
                Affiliations
                [1 ]Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
                Author notes
                *To whom correspondence should be addressed: Martin Ellenrieder, Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Strasse 142, D-18057 Rostock, Germany, Phone: +49(0)381/494-9363, Fax: +49(0)381/494-9311, E-mail: martin.ellenrieder@ 123456uni-rostock.de
                Article
                dgkh000173 Doc16 urn:nbn:de:0183-dgkh0001736
                10.3205/dgkh000173
                3252665
                22242097
                5cf478a8-21a2-4703-9d8c-b11db767de5c
                Copyright © 2011 Ellenrieder et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

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                Article

                Public health
                titanium-copper-nitride coating,total hip arthroplasty,spacer,infection
                Public health
                titanium-copper-nitride coating, total hip arthroplasty, spacer, infection

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