While
orthopedic implant-associated infections are rare, revision
surgeries resulting from infections incur considerable healthcare
costs and represent a substantial research area clinically, in academia,
and in industry. In recent years, there have been numerous advances
in the development of antimicrobial strategies for the prevention
and treatment of orthopedic implant-associated infections which offer
promise to improve the limitations of existing delivery systems through
local and controlled release of antimicrobial agents. Prior to translation
to in vivo orthopedic implant-associated infection
models, the properties (e.g., degradation, antimicrobial
activity, biocompatibility) of the antimicrobial materials can be
evaluated in subcutaneous implant in vivo models.
The antimicrobial materials are then incorporated into in
vivo implant models to evaluate the efficacy of using the
material to prevent or treat implant-associated infections. Recent
technological advances such as 3D-printing, bacterial genomic sequencing,
and real-time in vivo imaging of infection and inflammation
have contributed to the development of preclinical implant-associated
infection models that more effectively recapitulate the clinical presentation
of infections and improve the evaluation of antimicrobial materials.
This Review highlights the advantages and limitations of antimicrobial
materials used in conjunction with orthopedic implants for the prevention
and treatment of orthopedic implant-associated infections and discusses
how these materials are evaluated in preclinical in vivo models. This analysis serves as a resource for biomaterial researchers
in the selection of an appropriate orthopedic implant-associated infection
preclinical model to evaluate novel antimicrobial materials.