Selective Laser Melting of Integrated Ti6Al4V ELI Permeable Walls for Controlled Drug Delivery of Vancomycin.

Bacteria colonizing the surface of orthopedic implants are responsible for most postoperative periprosthetic joint infections. A possible alternative route for drug delivery is described in this study by utilizing the bulk of the implant itself as a reservoir. Drug release is enabled by manufacturing of integrated permeable structures possessing high porosity through application of selective laser melting technology. The concept was evaluated in two paths, with 400 µm permeable thin walls and with dense reservoirs containing an integrated 950 µm permeable wall. Components were designed and preprocessed as separate parts, allowing for allocation of different settings of laser power and scanning speed. Lowering the energy input into the selective laser melting process to induce intermittent melting of the Ti6Al4V ELI powder produced porous components through which vancomycin was released with differing profiles. Static water contact angle measurements demonstrated a significant effect on the hydrophilicity by permeable wall thickness. Relative porosities of the 400 µm structures were determined with microcomputed tomography analyses. A transition zone of 21.17% porosity was identified where release profiles change from porosity-dependent to near free diffusion. Antimicrobial activity of released vancomycin was confirmed through evaluation against Staphylococcus aureus Xen 36 in two separate agar diffusion assays. The approach is promising for incorporation into the design and manufacturing of next-generation prosthetic implants with controlled release of antibiotics in situ and the subsequent prevention of periprosthetic joint infections.

Titanium-Based Hip Stems with Drug Delivery Functionality through Additive Manufacturing.

Postoperative infections are a major concern in patients that receive implants. These infections generally occur in areas with poor blood flow and pathogens do not always respond to antibiotic treatment. With the latest developments in nanotechnology, the incorporation of antibiotics into prosthetic implants may soon become a standard procedure. The success will, however, depend on the ability to control the release of antibiotics at concentrations high enough to prevent the development of antibiotic-resistant strains. Through additive manufacturing, antibiotics can be incorporated into cementless femoral stems to produce prosthetic devices with antimicrobial properties. With the emerging increase in resistance to antibiotics, the incorporation of antimicrobial compounds other than antibiotics, preferably drugs with a broader spectrum of antimicrobial activity, will have to be explored. This review highlights the microorganisms associated with total hip arthroplasty (THA), discusses the advantages and disadvantages of the latest materials used in hip implants, compares different antimicrobial agents that could be incorporated, and addresses novel ideas for future research.

Delivery of antibiotics from cementless titanium-alloy cubes may be a novel way to control postoperative infections.

Bacterial colonisation and biofilm formation onto orthopaedic devices are difficult to eradicate. In most cases infection is treated by surgical removal of the implant and cleaning of the infected area, followed by extensive treatment with broad-spectrum antibiotics. Such treatment causes great discomfort, is expensive, and is not always successful. In this study we report on the release of vancomycin through polyethersulfone membranes from channels in cementless titanium-alloy cubes. The cubes were constructed with LaserCUSING from Ti6Al4V ELI powder. Vancomycin was released by non-Fickian anomalous (constraint) diffusion. Approximately 50% of the vancomycin was released within the first 17 h. However, sustained delivery of vancomycin for 100 h was possible by reinjecting the channels. Refillable implants may be a novel way to control postoperative infections.