Implant-associated
infections remain a major issue in orthopaedics and antimicrobial functionalization of the implant surface by
antibiotics or other
anti-infective agents have gained interest. The goal of this article is to identify antimicrobial coatings, for which clinical data are available and to review their clinical need, safety profile, and their efficacy to reduce
infection rates. PubMed database of the National Library of Medicine was searched for clinical studies on antimicrobial coated implants for
internal fracture fixation devices and
endoprostheses for bone surgery, for which study design, level of evidence, biocompatibility, development of resistance, and effectiveness to reduce
infection rates were analyzed. Four different coating technologies were identified:
gentamicin poly(d, l-lactide) coating for tibia nails, one high (MUTARS®) and one low amount
silver (Agluna) technology for
tumor endoprostheses, and one
povidone-iodine coating for
titanium implants. There was a total of 9 published studies with 435 patients, of which 7 studies were case series (level IV evidence) and 2 studies were case control studies (level III evidence). All technologies were reported with good systemic and local biocompatibility, except the development of local
argyria with blue to bluish grey skin discoloration after the use of
silver MUTARS® megaendoprostheses. For the local use of
gentamicin, there is contradictory data on the risk of emergence of
gentamicin-resistance strains, a risk that does not seem to exist for
silver and
iodine based technologies. Regarding reduction of
infection rates, one case control study showed a significant reduction of
infection rates by Agluna
silver coated
tumor endoprostheses. Based on socio-economic data, there is a strong need for improvement of
infection prevention and treatment strategies, including implant coatings, in fracture care, primary and revision
arthroplasty, and bone
tumor surgery. The reviewed
gentamicin,
silver Agluna, and
povidone-iodine technologies have shown a good risk benefit ratio for patients. Further data from randomized control trials are desirable, although this will remain challenging in the context of
infection prevention due to the required large sample size of such studies.