Hip prosthesis biomaterials: a challenge in prevention of biofilm formation

The objective of this study was to identify the scientific evidences regarding biofilm formation prevention on hip prosthesis biomaterials. It's an integrative review that aims to answer the following question: what are the scientific evidences regarding biofilm formation prevention on hip prosthesis biomaterials? The search was performed on PubMed portal and on databases: Web of Science, Embase, Cochrane, CINAHL and LILACS. Primary studies about the topic published online up until November 2017 in English, Spanish and Portuguese are included. Among 16 primary studies, 81.25% were in vitro experimental studies, in which polyethylene showed a higher biofilm formation than metallic biomaterials and polymethylmethacrylate. Among clinical studies, Staphylococcus epidermidis and Staphylococcus aureus were isolated in most of joint prosthesis components. New acylase-containing polyurethane coatings, silver-zirconium carbonitride films, bioactive gentamicin, biodegradable gentamicin-hydroxyapatite, vancomycin, titanium-silicon-carbon-oxygen-nitrogen films and cross-linked polyethylene combined with vitamin E and a poly(2-methacryloyloxyethyl phosphorylcholine) layer were developed to prevent biofilm formation. Moreover, cobalt-chromium (Co-Cr) ions inhibited bacterial growth, and cobalt-chromium particles reduced biofilm development. The biomaterials that presented properties against biofilm formation were: bioactive gentamicin, biodegradable gentamicin-hydroxyapatite, vancomycin, acylase-containing polyurethane, cross-linked polyethylene combined with vitamin E-blended and a poly(2-methacryloyloxyethyl phosphorylcholine) layer, silver-zirconium carbonitride films and titanium-silicon-carbon-oxygen-nitrogen films. Moreover, the Co-Cr particles released from metallic joint prosthesis showed higher antibiofilm activity than Co-Cr ions.