The Antibacterial Properties of a Silver Multilayer Coating for the Prevention of Bacterial Biofilm Formation on Orthopedic Implants-An In Vitro Study

The prevention of biofilm formation on orthopedic implants is essential, as biofilms are the main challenge in the effective treatment of periprosthetic joint infection (PJI). A silver multilayer (SML) coating was developed to prevent biofilm formation on the implant surface. Previous studies have already demonstrated its antibacterial properties without cytotoxic effects. However, the coating has not been previously tested when applied to common titanium surfaces used in total joint arthroplasty implants. These surfaces often have increased roughness and porosity in the case of cementless implants, which can alter the antibacterial effect of the coating. In this study, we assessed the antibacterial and anti-biofilm properties of the SML coating on corundum-blasted and plasma-sprayed microporous-coated titanium alloy surfaces, using S. aureus, S. epidermidis, and E. coli. An antibacterial activity test following the principles of ISO 22196, ASTM E2180-18, and JIS Z 2801 standards was performed, as well as a biofilm proliferation assay investigating bacterial adhesion and biofilm formation. The SML coating exhibited strong antibacterial effects for all bacterial strains. After 24 h biofilm culture, a >4-log reduction in CFU was induced by the SML coating for S. epidermidis and E. coli on the corundum-blasted and plasma-sprayed microporous-coated titanium surfaces, respectively, when compared to the uncoated surfaces. The coating showed bactericidal properties against Gram-positive bacteria on the corundum-blasted discs. The SML coating on two common titanium surfaces demonstrates significant potential as an effective strategy in combating PJI across a wide range of orthopedic implants.