Published in
N°001 - May / June 2019
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Antibacterial Hydrogel Coating of Implants in Orthopedics and Trauma: Surgical Technique and Clinical Applications
By Romanò CL (1, 2), Battaglia A (3), Suardi V (3), Romanò D (4), Baldi A (5), Zoccali C (5) in category UPDATE
(1)- Studio Medico Cecca-Romano - Milano, Italy / (2)- Romano Institute - Tirane, Albania - mail@romano.institute / (3)- Università degli Studi - Scuola di specializzazione Ortopedia, Milano, Italy / (4)- Department of Reconstructive Surgery of Osteo-articular Infections C.R.I.O. Unit, I.R.C.C.S. Galeazzi Orthopaedic Institute - Milano, Italy / (5)- Oncological Orthopedics, Regina Elena National Cancer Institute, Rome, Italy
Introduction
Up to 80% of human bacterial infections are biofilm-related, according to the U.S. National Institutes of Health [1]. Among these, implant-related infections in orthopaedics and trauma still have a tremendous impact [2]. In fact, peri-prosthetic joint infection (PJI) is among the first reasons for joint replacement failure [3], posing challenging diagnostic and therapeutic dilemmas [4], with extremely high economic and social associated costs (Table 1). [5]
Table 1. Impact of implant-related infections in orthopedics and trauma: facts and numbers.
Whenever a biomaterial is implanted, a competition between the host’s and the bacterial cells takes place for surface colonization. In the event of bacterial adhesion to an implant, immediate biofilm formation starts, making the bacteria extremely resistant to host’s defense mechanisms and to antimicrobials (Fig.1) [13].
Figure 1. Naked eye visible bacterial biofilm in a septic non-union of the distal third of the fibula, after the infected metallic plate and screws had been removed.
In fact, in a wet environment, like the human body is, bacteria are capable to immediately adhere on a surface and to produce a protective intercellular matrix (the “biofilm”), which is completely formed in few hours (Fig. 2). Once...
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