Table 4.
Summary of Advantages and Limitations of Composite Antimicrobial Biomaterials from the Past Decade Designed for Orthopedic Implant-Associated Infection Applications
| combination materials/composites | |||||
|---|---|---|---|---|---|
| composition | tested in vivo? | antimicrobial activity | advantages | limitations | ref |
| zirconium nitride coated ceramic covered Co–Cr–Mo | no | log10 decrease bacterial CFUs | (1) intrinsic activity | (1) short range of antimicrobial action (only prevent bacterial attachment to surface) | 149 |
| (2) long-lasting | |||||
| Titanium–niobium-nitride coated titanium | no | 4-fold decrease in bacterial adhesion | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 159 |
| (2) long-lasting | |||||
| nanostructured silver-substituted fluorhydroxyapatite-titanium oxide coated titanium | no | bacterial clearance of 100% CFUs | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 146 |
| (2) long-lasting | |||||
| (3) promote osseointegration | |||||
| carboxymethyl chitosan/hyaluronic-acid-catechol conjugated vascular endothelial growth factor functionalized titanium | no | inhibit adhesion of 46–84% bacteria | (1) intrinsic activity | (1) short range of antimicrobial action (only prevent bacterial attachment to surface) | 160 |
| (2) promotes osseointegration | |||||
| zinc, cerium, selenium substituted hydroxyapatite/poly(sorbitol sebacate glutamate) coated titanium | yes | 1 day activity zone of inhibition (in vitro) | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 147 |
| (2) promotes osseointegration | |||||
| silver hydroxyapatite coating on titanium | yes | 10–20% decrease in bacterial biofilm adhesion | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 148 |
| (2) long-lasting | |||||
| (3) promotes osseointegration | |||||
| silver doped nano calcium phosphate coated Ti6Al4V | yes | significant reduction in bacterial adhesion relative to controls | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 157 |
| (2) long-lasting | |||||
| (3) promotes osseointegration | |||||
| Eudragit coated Ti6Al4V | yes | 15 days activity zone of inhibition (in vitro) | (1) pH-triggered drug delivery | (1) require antibiotics | 161 |
| (2) limited duration of activity | |||||
| mesoporous silica microparticles in porous stainless steel | no | 2–3log10 decrease in bacterial adhesion | (1) tunable drug delivery properties | (1) require antibiotics | 162 |
| (2) limited duration of activity | |||||
| copper-nanoparticle coated sulfonated poly(ether ether ketone) | yes | 35-fold decrease in bacterial adhesion | (1) intrinsic activity | (1) leach metal particles (cytotoxicity/genotoxicity) | 114 |
| (2) long-lasting | |||||
| cationic liposomes in calcium sulfate | yes | bacterial clearance of 100% CFUs | (1) promote osseointegration | (1) require antibiotics | 28 |
| (2) limited duration of activity | |||||
| chitosan bonded borate bioglass particles | yes | 81–87% clearance of infection in vivo | (1) promotes osseointegration | (1) require antibiotics | 30 |
| (2) injectable | (2) limited duration of activity | ||||
| brushite calcium phosphate functionalized poly(ether ether ketone) | Yes | inhibit adhesion 100% bacteria | (1) promotes osseointegration | (1) require antibiotics | 113 |
| (2) limited duration of activity | |||||
| cyclodextrin microparticles in PMMA | No | 10–60 days activity zone of inhibition (in vitro) | (1) can be repeatedly filled with drug locally | (1) require antibiotics | 29, 123–125 |
| (2) unaffected by bacterial biofilm | |||||