Objective To prepare silver-containing hydroxyapatite coating (hydroxyapatite/Ag, HA/Ag) and investigate its antibacterial property and biocompatibil ity in vitro. Methods Vacuum plasma spraying technique was adopted to prepare HA/Ag coating on titanium alloy substrate (3% Ag). After incubating the HA/Ag and the HA coating under staphylococcus aureus and pseudomonas aeruginosa suspensions of 2% tryptic soy broth (TBS) medium for 2, 4 and 7 days, respectively, the biofilm on the coatings was examined by confocal laser scanning microscope, and the bacterial density and viable bacterial percentage of bacterial biofilm were calculated. Meanwhile, the micro-morphology of bacterial biofilm was observed by SEM, the cytotoxicity was detected via MTT and the biocompatibil ity of biofilm was evaluated by acute aemolysis test. Results Compared with HA coating, the bacterial biofilm’s thickness on the surface of HA/Ag coating witnessed no significant difference at 2 days after culture (Pgt; 0.05), but decreased obviously at 4 and 7 days after culture (P lt; 0.01). The bacterial density of the biofilm increased with time, but there was no significant difference between two coatings (P gt; 0.05) at 2, 4 and 7 days after culture. The viable bacterial percentage of the biofilms on the surface of HA/Ag coating decreased obviously compared with that of HA coating at 2, 4 and 7 days after cultureP lt; 0.01). The MTT notified the cytotoxic grade of both coatings was zero. The acute haemolysis assay showed that the hemolytic rate of HA/Ag and HA coating was 0.19% and 0.12%, respectively. Conclusion With good biocompatibil ity, significant antibacterial property against staphylococcus aureus and pseudomonas aeruginosa, no obvious cytotoxicity and no erythrocyte destruction, the vacuum plasma sprayed HA/Ag coating is a promising candidate for the surface of orthopedic metal implants to improve their osseointegration and antibacterial property.
Objective To summarize the technological evolution, clinical advantages, and cutting-edge development trends of cementless prostheses for total knee arthroplasty (TKA), so as to provide a reference for the clinical treatment of end-stage knee osteoarthritis and the research and development of prosthesis technology. MethodsRelevant researches and technical achievements over more than 40 years in the field of cementless prostheses for TKA were systematically reviewed. This study focused on iterative upgrades and carried out comprehensive analysis combined with clinical application data and revision-related studies. Results Benefiting from the advantage of cementless fixation, cementless prostheses can effectively avoid bone-cement-related complications. Prosthesis coating materials have undergone multi-generation iterations, and friction-interface materials present favourable prospects for bionic-oriented application. Robot-assisted surgical systems can markedly improve the primary-fixation reliability of biological prostheses.Conclusion Materials and surgical-assisted techniques for cementless prostheses keep being innovated and their clinical outcomes are continuously optimized. Artificial-intelligence-aided surgical planning and patient-specific customized prostheses will become the core research directions in this field.