title: Coatings and surface modifications imparting antimicrobial activity to orthopedic implants.
abstract: Bacterial colonization and biofilm formation on an orthopedic implant surface is one of the worst possible outcomes of orthopedic intervention in terms of both patient prognosis and healthcare costs. Making the problem even more vexing is the fact that infections are often caused by events beyond the control of the operating surgeon and may manifest weeks to months after the initial surgery. Herein, we review the costs and consequences of implant infection as well as the methods of prevention and management. In particular, we focus on coatings and other forms of implant surface modification in a manner that imparts some antimicrobial benefit to the implant device. Such coatings can be classified generally based on their mode of action: surface adhesion prevention, bactericidal, antimicrobial-eluting, osseointegration promotion, and combinations of the above. Despite several advances in the efficacy of these antimicrobial methods, a remaining major challenge is ensuring retention of the antimicrobial activity over a period of months to years postoperation, an issue that has so far been inadequately addressed. Finally, we provide an overview of additional figures of merit that will determine whether a given antimicrobial surface modification warrants adoption for clinical use.
authors.affiliation: Department of Bioengineering, University of Missouri, Columbia, MO, USA.
authors.forename: Roli
authors.initials: R
authors.lastname: Kargupta
authors.forename: Sangho
authors.initials: S
authors.lastname: Bok
authors.forename: Charles M
authors.initials: CM
authors.lastname: Darr
authors.forename: Brett D
authors.initials: BD
authors.lastname: Crist
authors.forename: Keshab
authors.initials: K
authors.lastname: Gangopadhyay
authors.forename: Shubhra
authors.initials: S
authors.lastname: Gangopadhyay
authors.forename: Shramik
authors.initials: S
authors.lastname: Sengupta
mesh_terms: D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible; D019736:Prostheses and Implants
chemical_list: D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible