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Enhancing Surgical Implants: Polished vs. Textured Surfaces for Infection Prevention

This article explores the role of different implant surface characteristics in surgical procedures, highlighting the advantages of polished implants over textured ones. Research indicates that polished implants resist bacterial infections significantly better, requiring a higher bacterial load to establish infection compared to porous counterparts. Additionally, polished surfaces facilitate better tissue integration, thereby reducing the risk of post-surgical complications such as infection. The findings emphasize the importance of implant material surface design in enhancing surgical outcomes.

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Enhancing Surgical Implants: Polished vs. Textured Surfaces for Infection Prevention

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  1. Surgery - Implants • Polished implants - thick fibrous capsule that does not adhere to implants: • Textured implants - fibrous cells adhere tightly to implants

  2. Surgery - Implants • Microtexture promotes cellular attachment Burnett DM. Exp Cell Research 164:1986 • Once tissue attachment achieved, bacterial progression retarded Myojin K. Biomed Metal Research 12:1978

  3. Surgery - Implants • Polished dense material resist acute bacterial infections • Polished material required 40x greater bacterial load to establish infection vs. porous implant Cordero J et al. JBJS 76Br:717,1994 Merritt K. J Biomed Material Research 13:101,1979

  4. Implants “the race for the surface” Gristina AG. Science 237:1588,1987 Tissue integration Implant Colonize ? infection

  5. Surgery - Implants Colonization - Moussa FW Am. Journal Ortho 26:617,1997 • Elective implant removal cultures - 10%positive in 21 pts • Colonization can occur without sepsis

  6. Surgery - Implants Melcher Ga et al. Injury 27:SC3-26, 1996 • In an inoculated infection model in rabbits • Titanium implants lower infection rate than ss • Solid IMN lower infection rate than cannulated • Reaming increased infection rates • Implants may matter • ? Statistically significant, clinically insignificant

  7. Surgery - Stable Implants Merritt K & Dowd JD. J Ortho Res 5:23,1987 • Contaminated rodent osteotomy • Infection rate • Unstabilized (71%) • Stabilized - IMN (38%) Worlock P. et al. Injury 25:31,1994 • Fracture - plate infection - 71% • Fracture - IMN infection - 35%

  8. Surgery - ImplantsSummary • In a contaminated wound, implants that are: • polished • solid • titanium • unreamed • may be advantageous in preventing infection

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