Anti-Periprosthetic Infection Strategies: From Implant Surface Topographical Engineering to Smart Drug-Releasing Coatings

Abstract

Despite advanced implant sterilization and aseptic surgical techniques, periprosthetic bacterial infection remains a major challenge for orthopedic and dental implants. Bacterial colonization/biofilm formation around implants and their invasion into the dense skeletal tissue matrices are difficult to treat and could lead to implant failure and osteomyelitis. These complications require major revision surgeries and extended antibiotic therapies that are associated with high treatment cost, morbidity, and even mortality. Effective preventative measures mitigating risks for implant-related infections are thus in dire need. This review focuses on recent developments of anti-periprosthetic infection strategies aimed at either reducing bacterial adhesion, colonization, and biofilm formation or killing bacteria directly in contact with and/or in the vicinity of implants. These goals are accomplished through antifouling, quorum-sensing interfering, or bactericidal implant surface topographical engineering or surface coatings through chemical modifications. Surface topographical engineering of lotus leaf mimicking super-hydrophobic antifouling features and cicada wing-mimicking, bacterium-piercing nanopillars are both presented. Conventional physical coating/passive release of bactericidal agents is contrasted with their covalent tethering to implant surfaces through either stable linkages or linkages labile to bacterial enzyme cleavage or environmental perturbations. Pros and cons of these emerging anti-periprosthetic infection approaches are discussed in terms of their safety, efficacy, and translational potentials.

A review on contemporary nanomaterial-based therapeutics for the treatment of diabetic foot ulcers (DFUs) with special reference to the Indian scenario

“…This particular approach eradicated biofilms of Staphylococcus aureus with less toxicity to mammalian cells. 199 Kim et al applied AMF-associated magnetic hyperthermia to damage the biofilms generated by Staphylococcus aureus in studies conducted in in vitro and in vivo models. 200 A critical structural design is essential for safe wound healing applications.…”

Biofunctionalization of 3D Printed Porous Tantalum Using a Vancomycin–Carboxymethyl Chitosan Composite Coating to Improve Osteogenesis and Antibiofilm Properties

“…6,7 So, it is difficult to cure PJI accompanied by a bacterial biofilm through conventional means. 8 Eventually, patients inevitably need to have the prosthesis removed and revision surgery is involved in clinical decision-making, 9 which greatly increases the economic burden of patients and seriously affects the quality of life. PJI's treatment costs more than five times as much as primary replacement and the estimated annual hospital costs of PJI in US are projected to be $1.85 billion by 2030.…”

“…Once a biofilm formed, the concentration of antibiotics required to kill bacteria in the biofilm becomes much more higher than that required to kill free bacteria, and the biofilm exists as a shelter for bacteria proliferation and spread. , So, it is difficult to cure PJI accompanied by a bacterial biofilm through conventional means . Eventually, patients inevitably need to have the prosthesis removed and revision surgery is involved in clinical decision-making, which greatly increases the economic burden of patients and seriously affects the quality of life. PJI’s treatment costs more than five times as much as primary replacement and the estimated annual hospital costs of PJI in US are projected to be $1.85 billion by 2030 .…”

A novel antibacterial gold nanoparticle layer with a self-cleaning ability through the production of oxygen bubbles

“…[10][11][12] Besides, (3) bacterial growth can be inhibited by antimicrobialleaching layers, which load antibiotics, antiseptics, and metal ions. [13][14][15] Although all the above strategies are effective under appropriate conditions, residual and drug-resistant bacteria remain intractable problems. 16 Antimicrobial peptide mimetics (AMPMs) are considered as a potential choice to solve the problem of bacterial drugresistance.…”

“…10–12 Besides, (3) bacterial growth can be inhibited by antimicrobial-leaching layers, which load antibiotics, antiseptics, and metal ions. 13–15 Although all the above strategies are effective under appropriate conditions, residual and drug-resistant bacteria remain intractable problems. 16…”