Medium-term results of the treatment of periprosthetic infection with carbon-coated spacers impregnated with silver

The aim of the study to evaluate the antibacterial activity and biological compatibility of alloy coatings based on two-dimensionally ordered linear chain carbon (TDOLCC) and medium-term results of treatment of periprosthetic infection with their use. Materials and Methods. Coatings based on TDOLCC were synthesized using alloying additions like nitrogen (TDOLCC+N) and silver (TDOLCC+Ag) on the surfaces of titanium plates and polystyrene plates by the ion-stimulated carbon condensation in a vacuum. The authors examined the superficial bactericidal activity of the coatings and its resistance to mechanical effects. The rate of formation of microbial biofilms by clinical isolates with multiple and extreme resistance to antibiotics was assessed by staining the samples with a solution of crystal violet. The cytotoxic effect of the coatings was evaluated in relation to the primary culture of fibroblasts and keratinocyte cells of the HaCaT line. Results. The authors observed pronounced superficial bactericidal effect of TDOLCC+Ag coating in respect of microorganisms of several taxonomic groups independently of their resistance to antibacterial drugs. TDOLCC+Ag coating proved capable to completely prevent microbial biofilm formation by antibiotic resistant clinical isolates of S. aureus and P. aeruginosa. Silvercontaining coating demonstrated mechanical resistance and preservation of close to baseline level of superficial bactericidal activity even after lengthy abrasion treatment. TDOLCC based coatings did not cause any cytotoxic effects. Structure of monolayers formed in cavities coated by TDOLCC+N and TDOLCC+Ag was indistinguishable from the monolayers in cavities of control plates. Conclusions. The high anti-film activity of DU LCC+Ag coatings was proved in experiment and clinical practice at the follow-up stage. The use of a spacer with a test coating allows you to quickly eliminate the inflammatory process, significantly reduce the number of relapses of PJI in cases of CS and TB infections, and reduce the number of hospital stay days. Evaluation of the mid-term results of PJI treatment gives grounds to predict active protection of the implant surface from colonization by microorganisms and the formation of microbial biofilms, which, together with drug antibiotic prophylaxis, provides a good therapeutic and prophylactic effect on the recurrence of periprosthetic infection.