As the number of joint arthroplasty and internal fixation surgeries continues to rise, the infection involving orthopaedic surgical implants is a devastating complication. The prospect of the increasing burden of these infection and its tremendous impact on patients, health institutions, and society is a significant public health concern. Biofilm formation is the essential characteristic of these infections. The success rate of treatment on biofilm infections such as antibiotic and debridement is lower than what excepted. Due to the recognized difficulty in eradicating biofilms once they have formed, the prevention of infection following prosthetic or device implantation continues to be the focus of intense research in orthopedics specialties. Bacteria-killing and bacteria-resistive are the two key points in prevention of biofilm formation. Surface-tethered bacteria-killing materials and bacteria-resistive materials implant coatings show great potential for the prevention of bioflim formation. Implant coatings that resist biofilm-based infections fall into two catergories: (1) passive coatings, which impede bacterial adhesion, including polyethylene glycol, zwitterionic polymers, vitamin E; (2) active coatings, which release pre-incorporated antimicrobials to kill bacteria upon contact, including antibiotics, antimicrobial peptides, silver and chitosan. Significant interests have been focused on implant surfaces integrating traditional antimicrobial agents with newly synthesized bacteria-resistant or bacteria-release materials in recent years, such as applying active and passive approaches simultaneously, applying active and passive approach sequentially and repeatedly switching between active and passive approaches.

Anti-infective agents; Coated materials, biocompatible; Prostheses and implants; Infection; Biofilms