Abstract
Implants are widely used in orthopedic surgery and are gaining attention of late. However, their use is restricted by implant-associated infections (IAI), which represent one of the most serious and dangerous complications of implant surgeries. Various strategies have been developed to prevent and treat IAI, among which the closest to clinical translation is designing metal materials with antibacterial functions by alloying methods based on existing materials, including titanium, cobalt, tantalum, and biodegradable metals. This review first discusses the complex interaction between bacteria, host cells, and materials in IAI and the mechanisms underlying the antibacterial effects of biomedical metals and alloys. Then, their applications for the prevention and treatment of IAI are highlighted. Finally, new insights into their clinical translation are provided. This review also provides suggestions for further development of antibacterial metals and alloys.
Highlights
Orthopedic implants, including fracture fixation devices, artificial prostheses that replace joints and intervertebral discs, and bone defect fillers, help maintain, support, and restore the structure and function of the musculoskeletal system (Wang and Tang, 2019)
This review summarizes the latest applications of antimicrobial metals and alloys for the prevention and treatment of orthopedic implant-associated infections (IAI) and recent developments for their fabrication
In vitro antibacterial assays carried out on a dynamic bioreactor system confirmed that their antibacterial rates against S. aureus and S. epidermidis are greater than 90% and that they are essentially non-toxic to osteoblasts
Summary
Orthopedic implants, including fracture fixation devices, artificial prostheses that replace joints and intervertebral discs, and bone defect fillers, help maintain, support, and restore the structure and function of the musculoskeletal system (Wang and Tang, 2019). Implant-associated infections (IAI) are one of the most common and serious complications in orthopedics and include fracture-related infection and prosthetic joint infection (PJI). IAI usually involves intricate interactions between bacteria, host cells, and implant materials. The coating forms an additional layer by loading or diffusing substances on the surface of the substrate, whereas surface modification refers to the modification of the thin layer on the surface of the substrate at the atomic, molecular, or geomorphological level (Premkumar et al, 2020) These two methods do not damage the overall performance of the material and only perform specific functions to achieve bacteriostatic or bactericidal characteristics; they are associated with limitations such as limited antibacterial time and coating delamination. We discuss the complex interactions between bacteria, materials, and host cells during IAI and the potential mechanisms of antibacterial metals and alloys. INTRICATE INTERACTIONS BETWEEN BACTERIA, IMPLANT MATERIALS, AND HOST CELLS IN IAI
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