Strategy | Features | Examples | Development stage | Limits |
---|---|---|---|---|
Passive surface finishing/modifications (PSM) | Prevention of bacterial adhesion | Hydrophilic surface | Preclinical | Limited antibacterial and antibiofilm activity |
Super-hydrophobic surface | ||||
Anti-adhesive polymers | Possible interference with osteointegration | |||
Nano-patterned surface | ||||
Albumin | Unknown long-term effects | |||
Hydrogels | Regulatory issues | |||
Biosurfactants | ||||
Active surface finishing/modifications (ASM) | Inorganic | Silver ions and nanoparticles | Market | Incomplete implant coating |
Questionable long-term toxicity | ||||
Limited versatility and applicability | ||||
Limited large-scale applications | ||||
Possible bacterial resistance induction | ||||
Costs | ||||
Other metals (copper, zinc, titanium dioxide etc.) | Preclinical | Questionable long-term toxicity | ||
Regulatory issues | ||||
Non-metals: Iodine | Clinical | Incomplete implant coating | ||
Questionable long-term toxicity | ||||
Challenging large-scale application | ||||
Regulatory issues | ||||
Other non-metal ions (selenium, grapheme, etc.) | Preclinical | Poorly studied compounds | ||
Coating resistance to press-fit insertion | ||||
Questionable long-term toxicity | ||||
Challenging large-scale application | ||||
Regulatory issues | ||||
Organic | Coated/linked antibiotics | Market | Unique application to nail coating | |
Long-term effects on osteointegration | ||||
Single antibiotic (gentamicin) | ||||
Covalently linked antibiotics | Preclinical | Incomplete implant coating. | ||
Questionable long-term toxicity | ||||
Challenging large-scale application | ||||
Regulatory issues | ||||
Antimicrobial peptides | No data on in vivo or clinical effects | |||
Cytokines | Coating resistance to press-fit insertion | |||
Enzymes and biofilm disrupting agents | Questionable long-term toxicity | |||
Challenging large-scale application | ||||
Chitosan derivatives | ||||
Synthetic | Non-antibiotic antimicrobial compounds | |||
Regulatory issues | ||||
“Smart” coatings | ||||
Combined | Multilayer coating | |||
Peri-operative antibacterial local carriers or coatings (LCC) | Not-biodegradable | Antibiotic-loaded polymethylmetacrylate | Market | Resistance and small-colony variants induction |
No antibiofilm effect | ||||
Incomplete implant coating | ||||
May not be used for cementless implants | ||||
Biodegradable | Antibiotic-loaded bone grafts and substitutes | Market | Limited availability | |
Not proven efficacy as implant coating | ||||
Cost | ||||
Fast-resorbable hydrogel | Market | Early clinical use and results |