Targeting the biofilm microenvironment: Advances in stimuli-responsive antibacterial coating strategies for implant-associated infections

Abstract

As the global population ages, the prevalence of age-related conditions such as osteoporosis continues to increase, leading to greater use of orthopedic implants. However, implant-associated infections can cause severe complications, including loss of implant function, limb sequelae, and increased mortality. Biofilm formation is a major contributor to persistent implant-associated infection. Although biofilm formation and treatment strategies are increasingly understood, conventional approaches remain limited by delayed action, drug resistance, and off-target effects. Intelligent stimuli-responsive materials that react to pathological microenvironments or externally applied stimuli therefore have considerable potential for implant-related applications. This review first outlines the mechanisms of biofilm formation and current treatment strategies, with emphasis on their advantages and limitations. We then summarize advances in stimuli-responsive antibiofilm materials in orthopedics and related fields. Finally, we discuss the remaining obstacles that must be addressed before implantable stimuli-responsive systems can effectively target the biofilm microenvironment and progress toward clinical translation.