Titania Nanotubes as Silver Nanoparticle Carriers to Prevent Implant-Associated Infection

Titanium (Ti) and its alloys are widely used in the orthopedic and dental fields because of their good mechanical properties, corrosion resistance and biocompatibility (Chu et al. 2002; Geetha et al. 2009; Liu et al. 2004). However, implant-associated infection remains one of the most prevalent and catastrophic postoperative complications (Zhao et al. 2009). Although the infection rate has been reduced to less than 5% on account of more thorough disinfection, strict aseptic surgical protocols and intraoperative systemic prophylactic treatment (Lee and Murphy 2013), the total number of people infected continues to increase because of growing medical demand for prosthetic replacements by the increasing aging population and prevalence of 86joint degenerative and periodontal diseases (Kurtz et al. 2012). Exogenously virulent bacteria such as Staphylococcus aureus and Escherichia coli and endogenously low-virulent ones such as coagulase-negative Staphylococci (CoNS) and Propionibacterium acnes (P. acnes) may serve as pathogens. The infection is mainly ascribed to bacteria adhesion, colonisation and finally formation of biofilms on the implant surface. Accurate diagnosis of the infection is sophisticated and time consuming, and it is difficult to treat such infection because bacteria in the biofilms are highly resistant to antibiotics (Mah and O’Toole 2001). Usually, extraction of the contaminated implant is the only viable option to eliminate the infection.