Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits

Abstract

Aim:

This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted.

Material and methods:

50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 10⁸ cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies.

Results:

The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C (p = 0.044), Group D (p = 0.040) and Group E (p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E.

Conclusions:

Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.

Keywords

Cancellous titanium implant infection risk late haematogenous infection trabecular metal

Get full access to this article

View all access options for this article.

References

Pulido

Ghanem

Joshi

, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008; 466: 1710–1715.

Pulido

Parvizi

Macgibeny

, et al. In hospital complications after total joint arthroplasty. J Arthroplasty 2008; 23: 139–145.

Bozic

Ries

. The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. J Bone Joint Surg Am 2005; 87: 1746–1751.

Kurtz

Ong

Lau

, et al. Prosthetic joint infection risk after TKA in the medicare population. Clin Orthop Relat Res 2010; 468: 52–56.

Gehrke

Alijanipour

Parvizi

. The management of an infected total knee arthroplasty. Bone Joint J 2015; 97–B: 20–29.

Karachalios

Koutalos

Komnos

. Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques. Hip Int 2014; 24(Suppl. 10): 44–47.

Poss

Thornhill

Ewald

, et al. Factors influencing the incidence and outcome of infection following total joint arthroplasty. Clin Orthop Relat Res 1984; 182: 117–126.

Berbari

Hanssen

Duffy

, et al. Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis 1998; 27: 1247–1254.

Rezapoor

Parvizi

. Prevention of periprosthetic joint infection. J Arthroplasty 2015; 30: 902–907.

10.

Melcher

Claudi

Schlegel

, et al. Influence of type of medullary nail on the development of local infection. An experimental study of solid and slotted nails in rabbits. J Bone Joint Surg Br 1994; 76: 955–959.

11.

Worlock

Slack

Harvey

, et al. The prevention of infection in open fractures: an experimental study of the effect of fracture stability. Injury 1994; 25: 31–38.

12.

Gristina

. Biomaterial-centered infections: microbial adhesion versus tissue integration. Science 1987; 237: 1588–1595.

13.

Cordero

Munuera

Folgueira

. Influence of metal implants on infection. An experimental study in rabbits. J Bone Joint Surg Br 1994; 76: 717–720.

14.

Friedman

. Concise review of mechanisms of bacterial adhesion to biomaterial surfaces. J Biomed Mater Res 1998; 43: 338–348.

15.

Song

Koo

Ren

. Effects of material properties on bacterial adhesion and biofilm formation. J Dent Res 2015; 94: 1027–1034.

16.

Petty

Spanier

Shuster

, et al. The influence of skeletal implants on incidence of infection. Experiments in a canine model. J Bone Joint Surg Am 1985; 67: 1236–1244.

17.

Arens

Schlegel

Printzen

, et al. ‬Influence of materials for fixation implants on local infection. J Bone Joint Surg Br 1996; 78: 647–651.

18.

Sambaziotis

Lovy

Koller

, et al. Histologic retrieval analysis of a porous tantalum metal implant in an infected primary total knee arthroplasty. J Arthroplasty 2012; 27: 1413.e5–e9.

19.

Tokarski

Novack

Parvizi

. Is tantalum protective against infection in revision total hip arthroplasty? Bone Joint J 2015; 97–B: 45–49.

20.

Matharu

Judge

Murray

, et al. Trabecular metal acetabular components reduce the risk of revision following primary total hip arthroplasty: a propensity score matched study from the national joint registry for England and Wales. J Arthroplasty 2018; 33: 447–452.

21.

Harrison

Stockley

, et al. Does tantalum exhibit any intrinsic antimicrobial or antibiofilm properties? Bone Joint J 2017; 99: 1153–1156.

22.

Matharu

Judge

Murray

, et al. Trabecular metal versus non-trabecular metal acetabular components and the risk of re-revision following revision total hip arthroplasty: a propensity score-matched study from the national joint registry for England and Wales. J Bone Joint Surg Am 2018; 100: 1132–1140.

23.

Laaksonen

Lorimer

Gromov

, et al. Trabecular metal acetabular components in primary total hip arthroplasty. Acta Orthop 2018; 89: 259–264.

24.

Poultsides

Papatheodorou

Karachalios

, et al. Novel model for studying hematogenous infection in an experimental setting of implant-related infection by a community-acquired methicillin-resistant S. aureus strain. J Orthop Res 2008; 26: 1355–1362.

25.

Quenfenberry

Carpenter

. Ferrets, rabbits and rodents: clinical medicine and surgery, 3rd ed. St. Louis: Saunders, 1997, pp. 147–154.

26.

Sdougkos

Chini

Papanastasiou

, et al. Community-associated Staphylococcus aureus infections and nasal carriage among children: molecular microbial data and clinical characteristics. Clin Microbiol Infect 2008; 14: 995–1001.

27.

Chini

Petinaki

Foka

, et al. Spread of Staphylococcus aureus clinical isolates carrying Panton-Valentine leukocidin genes during a 3-year period in Greece. Clin Microbiol Infect 2006; 12: 29–34.

28.

Vandenesch

Naimi

Enright

, et al. Community-acquired methicillin-resistant staphylococcus aureus carrying panton-valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003; 9: 978–984.

29.

Aggarwal

Bakhshi

Ecker

, et al. Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg 2014; 27: 399–406.

30.

Farr

. Prevention and control of methicillin-resistant Staphylococcus aureus infections. Curr Opin Infect Dis 2004; 17: 317–322.

31.

Murray

Baron

Jorgensen

, et al. Manual of clinical microbiology, 9th ed. Washington, DC: American Society for Microbiology, 2007, pp. 264–282.

32.

Gatselis

Malli

Papadamou

, et al. Direct detection of cardiobacterium hominis in serum from a patient with infective endocarditis by broad-range bacterial PCR. J Clin Microbiol 2006; 44: 669–672.

33.

Rothman

. No adjustments are needed for multiple comparisons. Epidemiology 1990; 1: 43–46.

34.

Stevens

George

. Exploring and engineering the cell surface interface. Science 2005; 310: 1135–1138.

35.

Jemat

Ghazali

Razali

, et al. Surface modifications and their effects on titanium dental implants. Biomed Res Int 2015; 2015: 791725.

36.

Anselme

Davidson

Popa

, et al. The interaction of cells and bacteria with surfaces structured at the nanometre scale. Acta Biomater 2010; 6: 3824–3846.

37.

Truong

Lapovok

Estrin

, et al. The influence of nano-scale surface roughness on bacterial adhesion to ultrafine-grained titanium. Biomaterials 2010; 31: 3674–3683.

38.

Lorenzetti

Dogša

Stošicki

, et al. The influence of surface modification on bacterial adhesion to titanium-based substrates. ACS Appl Mater Interfaces 2015; 7: 1644–1651.

39.

Gromov

Søballe

, et al. Quantitative mouse model of implant-associated osteomyelitis and the kinetics of microbial growth, osteolysis, and humoral immunity. J Orthop Res 2008; 26: 96–105.

40.

Bernthal

Stavrakis

Billi

, et al. A mouse model of post-arthroplasty Staphylococcus aureus joint infection to evaluate in vivo the efficacy of antimicrobial implant coatings. PLoS One 2010; 5: e12580.

41.

Nishitani

Sutipornpalangkul

de Mesy Bentley

, et al. Quantifying the natural history of biofilm formation in vivo during the establishment of chronic implant-associated Staphylococcus aureus osteomyelitis in mice to identify critical pathogen and host factors. J Orthop Res 2015; 33: 1311–1319.

42.

Wouthuyzen-Bakker

Sebillote

Lomas

, et al. Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention. J Infect 2019; 78: 40–47.

43.

Gristina

Naylor

Myrvik

. Mechanisms of musculoskeletal sepsis. Orthop Clin North Am 1991; 22: 363–371.

44.

Gristina

. Implant failure and the immuno-incompetent fibro-inflammatory zone. Clin Orthop Relat Res 1994; 106–118.

45.

Bökel

Brown

. Integrins in development: moving on, responding to, and sticking to the extracellular matrix. Dev Cell 2002; 3: 311–321.

46.

Curtis

Wilkinson

. New depths in cell behaviour: reactions of cells to nanotopography. Biochem Soc Symp 1999; 65: 15–26.

47.

Singh

Vyas

Patil

, et al. Quantitative characterization of the influence of the nanoscale morphology of nanostructured surfaces on bacterial adhesion and biofilm formation. PLoS One 2011; 6: e25029.

48.

Moojen

van Hellemondt

Vogely

, et al. Incidence of low-grade infection in aseptic loosening of total hip arhtroplasty. Acta Orthop Scand 2010; 81: 667–673.

49.

Boot

Moojen

Visser

, et al. Missed low grade infection in suspected aseptic loosening has no consequences for the survival of total hip arthroplasty. Acta Orthop 2015; 86: 678–683.

50.

Eckardt

Aberman

Cantwell

, et al. Biological fixation of hydroxyapatite-coated versus grit-blasted titanium hip stems: a canine study. Arch Orthop Trauma Surg 2003; 123: 28–35.

51.

Bobyn

Toh

Hacking

, et al. Tissue response to porous tantalum acetabular cups: a canine model. J Arthroplasty 1999; 14: 347–354.

52.

Bobyn

Stackpool

Hacking

, et al. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Am 1999; 81: 907–914.

53.

Søballe

Hansen

Rasmussen

, et al. Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions. J Orthop Res 1992; 10: 285–299.

54.

Scholvin

Moseley

Carrol

, et al. Highly porous reticulated titanium foam for orthopaedic implant applications. Paper presented at 2008 AAOS 75th Annual Meeting, March 3–5 2008; San Francisco, CA.

55.

Schildhauer

Robie

Muhr

, et al. Bacterial adherence to tantalum versus commonly used orthopedic metallic implant materials. J Orthop Trauma 2006; 20: 476–484.