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World J Orthop. Jun 18, 2016; 7(6): 361-369
Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.361
Antimicrobial technology in orthopedic and spinal implants
Adam EM Eltorai, Jack Haglin, Sudheesha Perera, Bielinsky A Brea, Roy Ruttiman, Dioscaris R Garcia, Christopher T Born, Alan H Daniels
Adam EM Eltorai, Sudheesha Perera, Roy Ruttiman, Warren Alpert Medical School, Brown University, Providence, RI 02906, United States
Jack Haglin, Department of Biology, Brown University, Providence, RI 02906, United States
Bielinsky A Brea, Center for Biomedical Engineering, Brown University, Providence, RI 02906, United States
Dioscaris R Garcia, Christopher T Born, Alan H Daniels, Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI 02906, United States
Author contributions: All the authors contributed to the conception and design of the work, revised carefully the content and approved the final version of the manuscript writing.
Conflict-of-interest statement: Dioscaris R Garcia: Materials Science Associates: Paid consultant. Christopher T Born: Biointraface: Stock or stock Options; Unpaid consultant; Illuminoss: Paid consultant; Stock or stock Options; Stryker: Paid consultant; Research support. Alan H Daniels: DePuy, A Johnson and Johnson Company: Other financial or material support; Paid consultant; Globus Medical: Paid consultant; Medtronic Sofamor Danek: Other financial or material support; Orthofix, Inc.: Research support; Osseus: Unpaid consultant; Stryker: Other financial or material support; Paid consultant. The other authors have no conflicts of interest. There is no conflict of interest associated with the senior author or coauthors who contributed their efforts to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alan H Daniels, MD, Assistant Professor, Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, 100 Butler Drive, Providence, RI 02906, United States. alan_daniels@brown.edu
Telephone: +1-401-3301420 Fax: +1-401-3301495
Received: February 3, 2016
Peer-review started: February 14, 2016
First decision: March 21, 2016
Revised: April 6, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: June 18, 2016
Core Tip

Core tip: Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines the latest orthopedic implant antimicrobial technologies-including updates on chitosan coatings, photoactive-based coatings, electrospinning technology, integrated biofilms-highlighting the current applications, supporting evidence, and clinically-promising future directions.