Wu, Ke; (2021) Development of antimicrobial ultra high molecular weight polyethylene materials for prosthetic joint application. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The prevalence of prosthetic joint infection is relatively low compared to other postoperative infections, however, due to the huge population of joint arthroplasty patients, the total number of prosthetic joint infection patients becomes significantly high. This thesis focuses on advancing potential prosthetic joint spacer material by modifying ultra high molecular weight polyethylene via different techniques. The first chapter comprises of three themes which are: i) general background knowledge of the polymer including its discovery, application and material characterisations; ii) an in-depth introduction about prosthetic joint infection, focusing on the epidemiological, pathogenetic and microbiological aspects and provides an extensive review of the current medical and surgical interventions to suppress prosthetic joint infection; iii) a literature review of the development of novel antimicrobial ultra high molecular weight polyethylene in which three representative studies were chosen as they have the most impact on the materials that have been elaborated in the core chapters. This thesis introduces three different modified antimicrobial ultra-high molecular weight polyethylene materials that have been developed over the past four years by the author and are ranked chronologically with gradually optimised material characterisation techniques and additional preclinical studies. Chapter 3 introduces an aerosol assisted chemical vapour deposition copper-coated ultra high molecular weight polyethylene demonstrated complete kill of the tested Gram-positive and Gram-negative bacteria in the dark. Chapter 4 and Chapter 5 investigate the antibacterial activity of two different metal nanocluster and photosensitiser impregnated ultra high molecular weight polyethylene materials under light sources with different intensities. The copper-coated polymer demonstrated approximately 5 log reductions in the numbers of both Gram-positive and Gram-negative bacteria within 15 minutes in the dark. Upon irradiation of low-intensity white light, the crystal violet and gold nanocluster incorporated polymer exhibited ca. 2.66 log reduction in bacterial numbers for lab strain S. aureus and ca. 2.85 log for lab strain E. coli in 24 h. An extremely high intensity white light was being used to activate the antimicrobial activity of the methylene blue and gold nanocluster UHMWPE. The material demonstrated efficacious antibacterial activity against both lab strains S. aureus and E. coli, by reducing bacterial numbers to below the detection limit within 30 min and 1.67 log in 2 h, respectively. When tested against clinical strain S. aureus and P. aeruginosa the material reduced bacterial numbers of below the detection limit within 30 min and 2 h, respectively. The modified polymers detailed in this thesis could ultimately be used as spacers in prosthesis, to reduce the associated incidence of prosthetic joint infection.

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