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Do crosslinking and vitamin E stabilization influence microbial adhesions on UHMWPE-based biomaterials?
Giuliana Banche1, Pierangiola Bracco, Valeria Allizond
1Department of Public Health and Pediatrics, University of Torino, Turin, Italy.
Clinical Orthopaedics and Related Research
|November 5, 2014
Summary
Crosslinked polyethylene (XLPE) and vitamin E-stabilized polyethylene (VE-PE) significantly reduce microorganism adhesion compared to standard polyethylene (PE). These advanced materials offer enhanced resistance to both bacterial and fungal colonization in joint arthroplasty.
Area of Science:
- Biomaterials Science
- Orthopedic Surgery
- Microbiology
Background:
- Microorganism adhesion to polyethylene in total joint arthroplasty is a significant clinical concern.
- While vitamin E-stabilized ultrahigh-molecular-weight polyethylene (UHMWPE) has been studied, first-generation, highly crosslinked UHMWPE (XLPE), common in clinical practice, remains less evaluated for microbial adhesion.
- Understanding microbial interactions with UHMWPE is crucial for improving implant longevity and patient outcomes.
Purpose of the Study:
- To compare the adherence of Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Candida albicans to virgin UHMWPE (PE), crosslinked UHMWPE (XLPE), and vitamin E-stabilized UHMWPE (VE-PE).
- To correlate microbial adhesion with surface properties of the biomaterials.
- To confirm if VE-PE reduces C. albicans adhesion, as previously observed for bacteria.
Main Methods:
- Microbial adhesion assays were performed over 48 hours using biofilm-producing strains (ATCC and clinical) on PE, XLPE, and VE-PE.
- Quantification of adhered microorganisms was done using colony-forming units (CFU)/mL via a sonication protocol.
- Surface characterization included scanning electron microscopy, roughness, contact angle, FTIR, and X-ray photoelectron spectroscopy (XPS) to assess topography and chemical composition.
Main Results:
- XLPE demonstrated significantly lower microorganism adhesion (18-25% at 48 hours) compared to PE (51-55%).
- Reduced adhesion on XLPE was observed for all tested microorganisms, including bacteria (S. epidermidis, S. aureus, E. coli) and fungi (C. albicans).
- VE-PE also showed decreased C. albicans adhesion compared to PE, confirming previous findings for bacterial adhesion.
Conclusions:
- Both vitamin E stabilization and crosslinking of UHMWPE effectively reduce microbial adhesion.
- XLPE and VE-PE exhibit enhanced resistance to both bacterial and fungal adhesion, suggesting potential clinical benefits in reducing implant-associated infections.
- Further research is necessary to fully elucidate the mechanisms underlying the modulation of microbial adhesion to medical-grade UHMWPE.
