Antimicrobial 3D printed implants for periprosthetic joint infections.

Abstract

Periprosthetic joint infections (PJIs) remain a serious complication following hip and knee arthroplasty, affecting 1-5% of patients in developed countries and posing significant challenges to patients, clinicians, and healthcare systems. Conventional prophylactic strategies, such as antibiotic-loaded bone cement, suffer from limited post-implantation drug release and potential compromise of mechanical integrity. To overcome these limitations, we developed a personalized, 3D-printed implant designed to integrate with the acetabular component of joint prostheses. These implants deliver either monotherapy or a combination of amphotericin B (AmB) and vancomycin (VAN), targeting both fungal and bacterial pathogens. Fabricated via fused deposition modeling using a biocompatible polyvinyl alcohol-polyethylene glycol (PVA-PEG) matrix, the implants enable passive drug loading and rapid adhesion to prosthetic surfaces within 60 s, minimizing operative time. In vitro testing confirmed broad-spectrum antimicrobial activity against Candida spp. (C. albicans, C. parapsilosis, C. glabrata, C. krusei) and Staphylococcus spp. (S. aureus, S. epidermidis). VAN was released rapidly, while AmB exhibited sustained release for up to 10 h, with both maintaining saturation solubility for 48 h. Notably, AmB-loaded implants showed five-fold lower hemolytic toxicity compared to free drug. These results highlight the potential of 3D-printed, drug-eluting implants as a clinically viable solution for the prevention and early treatment of PJIs.