二元取代壳聚糖季铵盐的抗菌活性

对合成的系列单取代和双取代壳聚糖季铵盐进行了抗菌试验。实验结果表明，单取代壳聚糖季铵盐抗菌活性弱于双取代壳聚糖季铵。在双取代壳聚糖季铵盐中，O-季铵化-N-壳聚糖内桂醛席夫碱的最低抑菌浓度（MIC）最小，对金黄色葡萄球菌和大肠杆菌的MIC分别达到了为0．01％和0．02％。试验结果表明，壳聚糖衍生物抗菌活性与结构之间有一定的构效关系。     

表皮葡萄球菌引起假体周围感染的生物膜形成机制

关节假体周围感染是人工关节置换术后严重的并发症之一。流行病学研究发现,表皮葡萄球菌是导致假体周围感染的最主要致病菌之一。感染过程中,细菌通过在植入物表面定植形成生物膜,从而有效逃避抗生素和宿主免疫反应,并通过群体感应系统调节生物膜的成长过程。该文就表皮葡萄球菌引起假体周围感染的生物膜形成机制作一综述。     

人工关节周围感染性生物膜的组织学观察

目的通过动物实验探索人工关节假体周围感染性生物膜的组成及生物膜在假体感染中的机制。方法以健康成年ＳＤ大鼠为研究对象,在置入假体的关节内注入ＳＬ－７６或Ｇ２亚型的表皮葡萄球菌,一周后以其表面的生物膜做细菌培养以断定是否存在感染。并利用ＨＥ、革兰氏。甲苯胺蓝。奥辛蓝－ＰＡＳ染色等方法观察所有生物膜的组织切片。结果所有的假体表面均有生物膜形成,感染性生物膜中有大量的成纤维细胞、炎性细胞、纤维蛋白以及葡萄球菌,在表皮葡萄球菌ＳＬ－７６组中尚有大量奥辛蓝染色呈蓝染的细胞外多粘质物质（ＥＳＳ）,而表皮葡萄球菌Ｇ２组则缺乏这种物质。结论ＥＳＳ可能是促进假体相关感染的关键性物质。     

骨科内置物感染葡萄球菌的研究进展

葡萄球菌是目前医院内最常见的致病菌,也是假体等骨科内置物周围感染的主要致病菌.1997～2005年UK卫生防护机构对手术部位感染的监测数据发现41.4%人工髋关节,33.5%人工膝关节,53%骨折切开复位以及59.1%髋部半关节成形术感染的病原菌为金黄色葡萄球菌.而凝固酶阴性葡萄球菌分别占这些感染的15.1%,20.7%,7.5%及6.3%.陈哲峰等调查国内人工关节术后假体周围感染的细菌学分布表明,金黄色葡萄球菌占总菌株数的34.59%,表皮葡萄球菌占总菌株数的37.48%; 46.7%的金黄色葡萄球菌和85.7%的表皮葡萄球菌株对甲氧西林耐药.     

金黄色葡萄球菌假体关节感染生物膜形成和调节的分子机制

假体关节感染是人工关节置换术灾难性的并发症;金黄色葡萄球菌是最主要的致病菌之一。生物膜在金葡菌假体关节感染的发生发展中扮演了重要角色,生物膜保护细菌免于机体免疫,抗生素和杀菌剂的攻击。生物膜的形成包括细菌的初始黏附,细菌聚集,生物膜成熟和细菌脱离生物膜回归游离态四个步骤。根据其主要成分,生物膜可分为多糖胞间粘附素依赖和非多糖胞间粘附素依赖两种;生物膜的其他成分还包括细胞外DNA和磷壁酸等。金黄色葡萄球菌的生物膜受激活或抑制生物膜组分的复杂信号分子网络调控的,包括agr基因控制的群体感应系统,受Sar A和sigma B调节的ica ADBC基因簇等。本文拟对金黄色葡萄球菌假体关节感染中生物膜形成和调节分子机制作简要综述。     

表皮葡萄球菌生物膜蛋白在假体周围感染诊断中的应用

目的探讨表皮葡萄球菌生物膜蛋白作为抗原诊断假体周围感染的临床价值。方法制作表皮葡萄球菌感染的假体周围感染动物模型，并收集临床假体周围感染患者的血清。以从表皮葡萄球菌444生物膜中提取的蛋白为抗原，用ELISA方法检测感染动物和临床假体周围感染患者的血清中IgG水平。蛋白印迹杂交寻找特异性抗原蛋白。结果感染动物和感染患者血清中的IgG水平明显高于各自对照组，Western—blot结果显示，表皮葡萄球菌生物膜蛋白大小在15KD-37KD之间具有良好的抗原性。结论表皮葡萄球菌生物膜蛋白成份具有良好的抗原性，是引起机体免疫的重要成份。进一步纯化这些蛋白组分并作为诊断假体周围表皮葡萄球菌感染的抗原，具有重要的临床价值。     

碘伏对钛合金表面金葡菌细菌生物膜抗菌活性的试验研究

[目的]观察碘伏对钛合金表面金黄色葡萄球菌细菌生物膜的体外抗菌活性。为临床上内置物相关感染的治疗方法提供参考。[方法]在钛合金表面建立金黄色葡萄球菌生物膜模型,通过激光共聚焦显微镜观察其结构。采用活菌计数法,了解碘伏对细菌生物膜的抗菌活性。[结果](1)有效碘浓度为0.1%的碘伏即可对生物膜内活细菌起到杀灭作用;(2)有效碘浓度为0.3%及更高浓度的碘伏可大幅度杀灭生物膜内活菌;(3)使用有效碘浓度为0.5%的碘伏浸泡5 min无法完全杀灭生物膜内细菌。[结论]碘伏对于24 h细菌生物膜内的活菌具有抗菌活性。有效碘浓度为0.3%以上的碘伏可以显著杀灭生物膜的细菌。将浓度提高至0.5%虽可杀灭生物膜内绝大部分细菌,但仍无法完全根除。     

载银羟基磷灰石抗菌涂层体外抗菌性能及生物相容性研究

目的 制备载银羟基磷灰石(hydroxyapatite/Ag,HA/Ag)复合涂层,并探讨其体外抗菌性能及生物相容性. 方法 采用真空等离子体喷涂技术于钛合金(Ti-6Al-4V)基体表面制备HA/Ag复合涂层(银质量百分比为3%).HA/Ag复合涂层及HA涂层分别于2%TBS金黄色葡萄球菌及铜绿假单胞菌液培养2、4、7 d后取出,激光扫描共聚焦显微镜观察两种涂层表面生物被膜形成情况,计算生物被膜细菌密度及活菌百分比;扫描电镜观察涂层生物被膜微观形态:MTT法检测细胞毒性及急性溶血实验评价涂层生物相容性. 结果 培养2 d,HA/Ag复合涂层表面金黄色葡萄球菌及铜绿假单胞菌生物被膜厚度与HA涂层比较差异无统计学意义(P>0.05);培养4、7 d,均较HA涂层明显减小(P<0.01).生物被膜细菌密度随时间延长而增多,培养2、4、7 d,两种涂层间比较差异无统计学意义(P>0.05).培养2、4、7 d,HA/Ag复合涂层表面金黄色葡萄球菌及铜绿假单胞菌生物被膜活菌百分比均较HA涂层明显减小(P<0.01).MTT法测定示两种涂层材料毒性分级均为0级,急性溶血实验示HA/Ag复合涂层及HA涂层材料溶血率分别为0.19%及0.12%. 结论 HA/Ag复合涂层有良好的生物相容性,对金黄色葡萄球菌及铜绿假单胞菌有明显抗菌作用,无明显细胞毒性和红细胞破坏性,可用于骨科金属植入材料表面提高其骨整合及抗菌性能.     

复合头孢曲松钠和BMP的壳聚糖抗菌成骨生物陶瓷的制备实验研究

目的 使用壳聚糖和磷酸钙骨水泥(CPC)复合头孢曲松钠和BMP,制备出一种具有成骨和抗感染作用的植骨材料.方法 使用不同成分和比例的壳聚糖固化液将磷酸钙骨水泥、头孢曲松钠和BMP共混制备抗菌成骨生物陶瓷,绘制头孢曲松钠的紫外吸光度-浓度标准直线,测定生物陶瓷中头孢曲松钠体外释放浓度.微生物法测定生物陶瓷体外抑菌效果.生物陶瓷埋于大鼠腿部肌袋研究其成骨性能.将生物陶瓷填充大鼠污染骨缺损模型,研究其抑菌和成骨作用.结果 生物陶瓷的优化制备方案为0.1 g磷酸钙骨水泥复合10.4 mg头孢曲松钠和0.5 mg BMP与2.4 ml同化液C混合后在60℃、100%湿度下固化24 h.该生物陶瓷体外释放稳定,微生物测定结果表明头孢曲松钠在体外释放持续1周高于金黄色葡萄球菌最小抑菌浓度,达到了局部抗菌效果,组织切片显示8周后埋于大鼠腿部肌袋的生物陶瓷周围有骨组织产生,污染骨缺损实验中白细胞计数和组织切片显示实验组较对照组炎症反应轻微,成骨显著.结论 复合头孢曲松钠、壳聚糖和BMP的抗菌成骨生物陶瓷有望成为治疗污染性骨缺损的理想材料.     

溴代呋喃酮对胸心外科聚氯乙烯材料表面表皮葡萄球菌生物膜形成的影响

目的探讨溴代呋喃酮对胸心外科聚氯乙烯(PVC)材料表面表皮葡萄球菌生物膜形成的影响,为生物材料表面改性研究及临床生物材料植入感染的防治提供新思路。方法选用化学结构具有代表性的三种溴代呋喃酮分为3组,呋喃酮1组:3,4-二溴基-5-羟基-呋喃酮;呋喃酮2组:4-溴-5-(4-甲氧基苯基)-3-(甲氨基)-呋喃酮;呋喃酮3组:3,4-二溴基-5,5-二甲苯基-2(5H)-呋喃酮;对照组:PVC材料用酒精浸泡5min;分别对4组PVC材料进行表面涂层改性,将改性过的PVC材料与表皮葡萄球菌共同培育;分别于培养6h、12h、18h和24h时用激光共聚焦显微镜动态观察PVC材料表面细菌群落及细菌生物膜厚度的形成,扫描电子显微镜观察PVC材料表面细菌生物膜表面结构。结果激光共聚焦显微镜观测结果显示:呋喃酮2组各时间点PVC材料表面表皮葡萄球菌群落数量和细菌生物膜厚度明显小于对照组(P0.05),呋喃酮1组、呋喃酮3组表皮葡萄球菌群落数量和细菌生物膜厚度与对照组比较差异无统计学意义(P0.05)。扫描电子显微镜观察显示:与对照组比较,呋喃酮2组6h时PVC材料表面细菌群落附着数量较少;18h时对照组PVC材料表面细菌生物膜结构初步形成,而呋喃酮2组无明显细菌生物膜结构形成。结论不同溴代呋喃酮对PVC材料表面表皮葡萄球菌生物膜形成的影响不同,呋喃酮2可以抑制PVC材料表面表皮葡萄球菌群落数量和细菌生物膜厚度的形成。     

Antibacterial efficacy of quaternized chitosan coating on 3D printed titanium cage in rat intervertebral disc space

BACKGROUND CONTEXTInfection around intervertebral fusion cages can be intractable because of the avascular nature of the intervertebral disc space. Intervertebral cages with antibacterial effects may be a method by which this complication can be prevented.PURPOSETo investigate the bacterial load on the antibacterial coating cages for spinal interbody fusionSTUDY DESIGNAn experimental in vitro and in vivo study.METHODSBased on the micro-computed tomography (CT) data of rat caudal discs, mesh-like titanium (Ti) cages that anatomically fit into the discs were fabricated by three-dimensional (3D) printing. Additionally, an antibacterial coating was applied with quaternized chitosan (hydroxypropyltrimethyl ammonium chloride chitosan, HACC). In vitro release kinetics of the HACC was performed, and the antibacterial performance of the HACC-coated (Ti-HACC) cages (via inhibition zone assay, bacterial adhesion assay, and biofilm formation assay) was evaluated. Then, Ti-HACC- or noncoated (Ti) cages were implanted in the caudal discs of rats with bioluminescent Staphylococcus aureus. Bacterial survival was investigated using an in vivo imaging system (IVIS) on postoperative days 1, 3, and 5. On day 5, the infection-related changes (bone destruction and migration of cages) were assessed using micro-CT, and the healing status of the surgical wounds was also assessed. After the removal of the cages, the quantification of bacteria attached to the cages was obtained by IVIS. Histological evaluation was performed by hematoxylin and eosin staining and TRAP (tartrate-resistant acid phosphatase) staining.RESULTSRelease kinetic analysis showed the sustained release of HACC over 3 days from Ti-HACC cages. Antibacterial effects of Ti-HACC cages were demonstrated in all in vitro assays. IVIS evaluation indicated that the in vivo implantation of Ti-HACC cages with S. aureus exhibited better wound healing, less infection-related changes on micro-CT, and reduced bacterial quantity in the extracted cages compared to Ti cages. Histological evaluation demonstrated an increased number of TRAP-positive osteoclasts and severe bone destruction in the rats treated with Ti cages.CONCLUSIONSWe developed a novel antibacterial HACC-coated intervertebral cage that exhibited prominent antibacterial efficacy and prevented the structural damage caused by the infection in rat caudal discs.Clinical SignificanceHACC-coated titanium intervertebral cages may be a promising option for preventing intractable postoperative infection in spinal interbody fusion surgery.     

万古霉素阳离子脂质体复合纳米羟基磷灰石/壳聚糖/魔芋葡苷聚糖支架对金黄色葡萄球菌生物膜体外抑制作用

目的：研究万古霉素阳离子脂质体（ CLVs）复合纳米羟基磷灰石/壳聚糖/魔芋葡苷聚糖支架对金黄色葡萄球菌生物膜的抑制作用。方法采用微量肉汤稀释法测定药物对金黄色葡萄球菌的最小抑菌浓度,采用再生实验方法研究支架释放的CLVs对金黄色葡萄球菌生物膜的敏感性。结果万古霉素和CLVs对金黄色葡萄球菌的最小抑菌浓度分别为1．0 mg/L和0．6 mg/L;相同浓度的万古霉素脂质体复合支架对细菌生物膜的作用在低浓度和短时间的接触较游离万古霉素支架更有效。结论 CLVs复合纳米羟基磷灰石/壳聚糖/魔芋葡苷聚糖支架可以作为新的载药系统,在临床治疗生物膜感染方面可起到重要作用。     

不同浓度壳聚糖涂层PLGA材料与许旺细胞相容性研究

目的：研究不同浓度壳聚糖涂层聚乳酸／羟基乙酸共聚物（PLGA）材料与许旺细胞（sc）的生物相容性,为构建适合神经再生的导管支架提供研究基础。方法：采用双酶法培养扩增sc,用质量百分比浓度分别为1％,3％,5％,7％的壳聚糖涂层于PLGA材料。将SC与材料浸提液联合培养,并设立对照作比较,观察细胞生长增殖情况,分别在1,3,5,7天取材MTT法检测细胞相对增殖率。将sC接种在各组材料上,用相差显微镜和扫描电镜观察细胞在材料上粘附和生长情况。结果：材料浸提液对sc生长及细胞形态无明显影响,浓度为1％和3％壳聚糖涂层PLGA材料浸提液在第5天和第7天细胞相对增殖率要高于以5％和7％壳聚糖涂层。sc在壳聚糖涂层PLGA材料上粘附紧密,生长增殖良好。结论：壳聚糖涂层PLGA材料与sc生物相容性良好,采用质量浓度为1％～3％壳聚糖涂层有利于sc粘附增殖,较适合构建神经导管组织工程材料。     

骨髓间充质干细胞经脾移植治疗大鼠急性肝功能衰竭的实验研究

目的 探讨大鼠骨髓间充质干细胞（MSCs）经脾移植治疗急性肝功能衰竭的疗效，并观察MSCs在体内的迁徙情况。方法 收集1只SD雄性大鼠胫骨及股骨的骨髓，采用密度梯度离心联合贴壁培养法分离、纯化及扩增雄性SD大鼠的骨髓MSCs，再行免疫组化染色以观察第4代骨髓MSCs的表面标志物。联合应用D-氨基半乳糖和肿瘤坏死因子-α （TNF-α）建立24只雌性大鼠急性肝功能衰竭模型，将其随机分为2组：实验组（n=12）大鼠于造模后24 h行骨髓MSCs脾内移植；空白对照组（n=12）仅于脾内注射0.5 mL生理盐水。2组大鼠于移植后均取血检测丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）及白蛋白（ALB）水平，采用PCR法检测大鼠肝脏组织中Y性别决定区基因（SRY基因）的表达，并行HE染色观察肝脏组织的病理学改变。结果 第4代MSCs表达CD44和CD29，但不表达CD34。MSCs移植72 h及以后，实验组存活5只大鼠（41.7%），空白对照组存活3只大鼠（25.0%），2组大鼠的存活率比较差异有统计学意义（P＜0.05），实验组较高。将雄性大鼠的骨髓MSCs移植于雌性大鼠的脾内后，在雌性大鼠肝脏中能检测到SRY基因的表达；且HE染色结果显示，实验组大鼠的肝功能在移植后4周明显改善。移植后与空白对照组比较，实验组各时点的ALT和TBIL水平均较低（P＜0.05）；移植后1周和2周，实验组的ALB水平均高于空白对照组（P＜0.05）。结论 骨髓MSCs经脾内移植后迁徙并定居于受损的肝脏内，可替代肝细胞的功能。     

偶联多种单链抗体免疫纳米微粒的制备方法及鉴定

【摘要】 目的 建立一种多单链抗体修饰氧化铁纳米微粒的方法。方法 利用聚乙二醇（polyethylene glycol, PEG）及羧基（COOH group）修饰的氧化铁纳米微粒（Iron Oxide Nanoparticles, IONPs）,以及抗MUC4、抗CEACAM6及抗CD44v6单链抗体（Single chain antibodies, scAbs）,通过EDC/Sulfo?NHS交联剂将IONPs?PEG与3种scAbs进行交联,构建IONPs?PEG?multi scAbs复合物,再利用zeta粒度仪、透射电子显微镜（TEM）对IONPs?multi scAbs复合物进行表征,同时,在IONPs?PEG表面偶联荧光抗体,通过荧光强度测定其偶联效率;再鉴定复合物的抗原识别特异性及在放置1个月、6个月后评估复合物水溶液稳定性。结果 偶联3种scAbs后,IONPs?PEG?multi scAbs复合物的平均粒径为（23.6±0.5） nm,粒径分布集中,zeta电位约（?17.3±06） mV;TEM显示粒径约10 nm,荧光强度测定结果提示抗体偶联效率约为75%,细胞免疫荧光实验结果提示IONPs?PEG?multi scAbs复合物对高表达MUC4、CEACAM6及CD44v6分子的胰腺癌细胞BxPC?3具有特异性识别能力,证实该复合物具有良好的抗原识别特异性;在放置1个月、6个月后,偶联复合物的溶液分散性良好,放置6个月后平均粒径约（23.9±0.8） nm,zeta电位约（?17.6±0.4） mV,TEM拍照提示粒径约10 nm,细胞免疫荧光提示复合物抗原识别特异性良好。结论 本研究利用EDC/Sulfo?NHS交联剂组合,将3种单链抗体交联到PEG和羧基修饰的IONPs表面,构建IONPs?PEG?multi scAbs复合物,该方法偶联效率高,且复合物具有粒径小、分散性好、抗原识别特异性及水溶液稳定性好的特性。     

EPA covalently bound to smooth titanium surfaces decreases viability and biofilm formation of Staphylococcus epidermidis in vitro

Colonization of implant surfaces with bacteria should ideally be prevented right from implantation, as bacteria attaching to the surface will form a biofilm, being then well protected against antibiotic treatment. Therefore, implant coatings should combine antibacterial properties with biocompatibility towards their host tissue. We tested a UV‐induced covalent coating procedure with eicosapentaenoic acid (EPA) for smooth titanium (Ti) surfaces for its ability to prevent attachment and proliferation of Staphylococcus epidermidis and to allow mineralization of MC3T3‐E1 osteoblasts. Bacterial initial attachment was highest for EPA‐coated surfaces, but was reduced by vigorous washing, possibly due to low adhesive strength on those surfaces. We found an increase in the ratio of dead bacteria and in overall biofilm after 16 h on Ti surfaces with covalently bound EPA compared to Ti. The UV‐induced EPA coating did not impair the ability of MC3T3‐E1 preosteoblasts to mineralize, while a reduction in mineralization could be found for UV‐irradiated Ti surfaces and UV‐irradiated surfaces washed with ethanol compared to Ti. Although in vivo studies are needed to evaluate the clinical significance, our results indicate that covalent coating of Ti surfaces with EPA by UV irradiation decreases the survival of S. epidermidis and maintains the mineralization ability of osteoblasts. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1384–1390, 2012     

In vitro resistance to bacterial biofilm formation on coated fluoroplastic tympanostomy tubes.

Bacterial biofilm formation has been implicated in persistent posttympanostomy otorrhea and irreversible tube contamination. The use of a tympanostomy tube with a resistance to biofilm formation by the most common organisms associated with persistent infection may decrease the incidence of chronic otorrhea and the need for tube removal. In this investigation, scanning electron microscopy was used to compare a phosphorylcholine-coated fluoroplastic tympanostomy tube to plain fluoroplastic and silver oxide-impregnated fluoroplastic for resistance to biofilm formation after in vitro incubation with Staphylococcus aureus or Pseudomonas aeruginosa. Only a biofilm from Pseudomonas formed on the untreated fluoroplastic tubes, whereas the silver oxide-impregnated tubes developed biofilms from both S aureus and P aeruginosa. In contrast, the coated fluoroplastic tube showed resistance to both staphylococcal and pseudomonal biofilm adhesion. This is the first study to demonstrate the effect of a surface treatment of fluoroplastic as a method to inhibit biofilm formation by both S aureus and P aeruginosa. This reinforces our previous studies showing that surface-adherence properties such as charge or slickness or both may be more beneficial than antibacterial treatments in preventing film adhesion.     

Biocompatibility,encrustation and biodegradation of ofloxacine and silver nitrate coated poly-L-lactic acid stents in rabbit urethra

The purpose of this study was to evaluate the biocompatibility, encrustation and biodegradation properties of silver nitrate and ofloxacine blended caprolactone-L-lactide copolymer coated self-reinforced poly-L-lactic acid (SR-PLLA) urospirals in situ in the male rabbit urethra. SR-PLLA urospirals coated with 10% by weight silver nitrate or 5% by weight ofloxacine blended copolymer or pure copolymer were inserted into the posterior urethra of 18 male rabbits. No prophylactic antibiotics were given. The animals were sacrificed 1 or 6 months after insertion. Urethral tissue reactions were histologically scored semiquantitavely and the appearence of the stents assessed using scanning electron microscopy. The biodegradation time of SR-PLLA stents was remarkably reduced by the caprolactone coating. Silver nitrate and ofloxacine blended copolymer coated urospirals caused less tissue reaction than urospirals with a pure copolymer coating. Silver nitrate coating effectively prevented biofilm formation and stent encrustation. Silver nitrate and ofloxacine blended copolymer coated SR-PLLA urospirals had good biocompatibility properties in rabbit urethra. In particular, coating with silver nitrate may provide possibilities of preventing bacterial adhesion to bioabsorbable stents.     

Silver oxide‐containing hydroxyapatite coating supports osteoblast function and enhances implant anchorage strength in rat femur

Antibacterial silver with hydroxyapatite (Ag–HA) is a promising coating material for imparting antibacterial properties to implants. We previously reported that 3% (w/w) silver with HA (3% Ag–HA) has both antibacterial activity and osteoconductivity. In this study, we investigated the effects of Ag–HA on the in vitro osteoblast function and the in vivo anchorage strength and osteoconductivity of implants. Production of the osteoblast marker alkaline phosphatase, but not cytotoxicity, was observed in cells of the osteoblast cell line MC3T3‐E1 cultured on the 3% Ag–HA‐coated surface. These results were similar to those observed with silver‐free HA coating. In contrast, a significant high level of cytotoxicity was observed when the cells were cultured on a 50% Ag–HA‐coated surface. The anchorage strength of implants inserted into the femur of Sprague–Dawley (SD) rats was enhanced by coating the implants with 3% Ag–HA. On the 3% Ag–HA‐coated surface, both metaphyseal and diaphyseal areas were largely covered with new bone and had adequate osteoconductivity. These results suggest that 3% Ag–HA, like conventional HA, promotes osteogenesis by supporting osteoblast viability and function and thereby contributes to sufficient anchorage strength of implants. Application of 3% Ag–HA, which combines the osteoconductivity of HA and the antibacterial activity of silver, to prosthetic joints will help prevent postoperative infections. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:1391–1397, 2015.