Development of hydrofluoric acid-cleaned silicon nitride implants for periprosthetic infection eradication and bone regeneration enhancement.

Orthopedic implant is commonly associated with occurrence or relapse of osteomyelitis. This study developed a hydrofluoric acid (HF) cleaned silicon nitride (Si3N4) implant Si3N4_AC for osteomyelitis control and established a rat tibial osteomyelitis model to evaluate its efficacy on eradicating periprosthetic infection and enhancing bone regeneration. In vitro studies revealed Si3N4_AC had improved biocompatibility and inhibited Staphylococcus aureus adhesion. A custom-made Si3N4_AC implant was prepared and inserted into the rat tibia longitudinal cavity inoculated with Staphylococcus aureus. The in vivo bacteriostatic and osteogenic efficacies of Si3N4_AC implant were evaluated by histological, microbiological and Micro-CT analyses and compared with implants of pure Ti and Si3N4 . Si3N4_AC implant group revealed 99.5% inhibition of periprosthetic Staphylococcus aureus compared to the osteomyelitis group after 14 days post-operation. Implant-adhering bacteria density of Si3N4_AC was also much lower than pure Ti and Si3N4. In addition, micro-CT evaluation of peri-implant bone formation under the condition of periprosthetic osteomyelitis after 30 days post-surgery confirmed the osteogenic ability of Si3N4_AC. Taken together, Si3N4_AC can be an effective orthopedic biomaterial to eradicate periprosthetic infection and enhance bone regeneration.