Despite advanced implant sterilization and aseptic surgical techniques, periprosthetic
bacterial infection remains a major challenge for orthopedic and
dental implants. Bacterial colonization/biofilm formation around implants and their invasion into the dense skeletal tissue matrices are difficult to treat and could lead to implant failure and
osteomyelitis. These complications require major
revision surgeries and extended
antibiotic therapies that are associated with high treatment cost, morbidity, and even mortality. Effective preventative measures mitigating risks for implant-related
infections are thus in dire need. This review focuses on recent developments of anti-periprosthetic
infection strategies aimed at either reducing bacterial adhesion, colonization, and biofilm formation or killing bacteria directly in contact with and/or in the vicinity of implants. These goals are accomplished through antifouling, quorum-sensing interfering, or bactericidal implant surface topographical engineering or surface coatings through chemical modifications. Surface topographical engineering of lotus leaf mimicking super-hydrophobic antifouling features and cicada wing-mimicking, bacterium-piercing nanopillars are both presented. Conventional physical coating/passive release of bactericidal agents is contrasted with their covalent tethering to implant surfaces through either stable linkages or linkages labile to bacterial
enzyme cleavage or environmental perturbations. Pros and cons of these emerging anti-periprosthetic
infection approaches are discussed in terms of their safety, efficacy, and translational potentials.