Implant infection is one of the most severe complications after orthopedic surgery. The construction of an antibacterial coating on orthopedic implants with release-killing or contact-killing is one of the most efficient strategies to prevent implant-related infections. Here we reported a hydroxypropyltrimethyl ammonium chloride chitosan (HACC) based multilayer modified plasma-sprayed porous titanium coating generated via the layer-by-layer covalent-immobilized method. We demonstrated that the multilayer coating inhibited the colonization and biofilm formation of several bacterial strains, including Staphylococcus aureus (ATCC 25923), methicillin-resistant Staphylococcus aureus (MSRA, ATCC 43300) and clinical isolates of methicillin-resistant Staphylococcus epidermidis (MRSE 287), in vitro. HACC in the multilayer was released slowly with the degradation of the coating under the action of collagenase, further killing the planktonic bacteria, while the remaining HACC could kill the colonized bacteria. In a rat model of femur implants, the HACC-based multilayer-modified TCs effectively controlled the infection caused by MRSA and prevented bone destruction. Therefore, the HACC-based multilayer modified TCs with multiple antimicrobial properties could be a new potential ideal surface modification strategy to prevent implant associated infections.

Corneal transplantation is currently the major solution in the treatment of severe corneal diseases. However, it is restricted due to the limited number of corneal donors. A tissue-engineered cornea is a potential substitute which could help overcome this limitation. This research envisages the development of a novel tissue-engineered corneal stroma consisting of bacterial cellulose (BC)/poly(vinyl alcohol) (PVA) hydrogel composites for reconstructing the cornea. It was found that the properties of BC/PVA were better suited for use as a corneal stroma material than the BC hydrogel. The human corneal stromal cells (hCSCs) were used to evaluate the cytotoxicity of the materials, wherein BC/PVA displayed excellent biocompatibility with these cells. Furthermore, in the in vivo studies, the BC/PVA was transplanted intrastromally in rabbits. After four weeks, the cornea remained almost transparent, and without obvious inflammation, sensitization or neovascularization, as confirmed by the clinical and histological examinations. Our results demonstrate that BC/PVA was well-tolerated in the rabbit cornea, and may be a potential substitute for corneal stroma.