eCM (Eur Cell Mater / e Cells & Materials) Not-for-profit Open Access
Created by Scientists, for Scientists
 ISSN:1473-2262         NLM:100973416 (link)         DOI:10.22203/eCM

2012   Volume No 23 – pages 362-370

Title: Molecular engineering of an orthopaedic implant: from bench to bedside

Author: IM Shapiro, NJ Hickok, J Parvizi, S Stewart, TP Schaer

Address: Department of Orthopaedic Surgery, Jefferson Medical College, Thomas Jefferson University, 1015 Walnut Street, Suite 510, Philadelphia, PA 19146, USA

E-mail: irving.shapiro at

Key Words: vancomycin; orthopaedic implant; biofilm; infection; silane chemistry; animal model

Publication date: May 24th 2012

Abstract: The use of metallic implants has revolutionised the practice of orthopaedic surgery. While the safety and biocompatibility of these devices are excellent, a small percentage becomes infected. These infections are due to the formation of a biofilm that harbours bacteria encased in a complex extracellular matrix. The matrix serves as a barrier to immune surveillance as well as limiting the biocidal effects of systemic and local antibiotics. The objective of the review is to describe a novel approach to controlling implant infection using an antibiotic that is linked to titanium through a self-assembled monolayer of siloxy amines. We show that the hybrid-engineered surface is stable, biocompatible and resists colonisation by bacterial species most commonly associated with implant-related infections. Studies with rodent bone infection models suggest that the engineered titanium surface prevents bone infection. Results of a very recent investigation utilising a sheep model of infection indicate that the titanium-tethered antibiotic controls infection without compromising bone formation and remodelling. From all of these perspectives, the tethered antibiotic holds promise of providing a novel and practical approach to reducing implant-associated infections.

Article download: Pages 362-370 (PDF file)
DOI: 10.22203/eCM.v023a28