Antibacterial efficacy of a new gentamicin-coating for cementless prostheses compared to gentamicin-loaded bone cement

Abstract

Cementless prostheses are increasingly popular but require alternative prophylactic measures than the use of antibiotic-loaded bone cements. Here, we determine the 24-h growth inhibition of gentamicin-releasing coatings from grit-blasted and porous-coated titanium alloys, and compare their antibacterial efficacies and gentamicin release-profiles to those of a commercially available gentamicin-loaded bone cement. Antibacterial efficacy increased with increasing doses of gentamicin in the coating and loading with 1.0 and 0.1 mg gentamicin/cm(2) on both grit-blasted and porous-coated samples yielded comparable efficacy to gentamicin-loaded bone cement. The coating had a higher burst release than bone cement, and also inhibited growth of gentamicin-resistant strains. Antibacterial efficacy of the gentamicin coatings disappeared after 4 days, while gentamicin-loaded bone cement exhibited efficacy over at least 7 days. Shut-down after 4 days of gentamicin-release from coatings is advantageous over the low-dosage tail-release from bone cements, as it minimizing risk of inducing antibiotic-resistant strains. Both gentamicin-loaded cement discs and gentamicin-coated titanium coupons were able to kill gentamicin-sensitive and -resistant bacteria in a simulated prothesis-related interfacial gap. In conclusion, the gentamicin coating provided similar antibacterial properties to those seen by gentamicin-loaded bone cement, implying protection of a prosthesis from being colonized by peri-operatively introduced bacteria in cementless total joint arthroplasty.