The art of biodegradable polymer design for the treatments against osteomyelitis

Osteomyelitis arises from the incomplete treatment of the external wounds in the healing process, while bacterial infections persist within the bone marrow, leading to abscess formation. Osteomyelitis treatments generally involve three main aspects: rapid bactericidal action, sustained bacteriostasis, and induction of bone regeneration. However, current treatment methods, which often combine surgical debridement with long-term high-dose intravenous antibiotic administration or poly(methyl methacrylate) (PMMA) beads antibiotic therapy, suffer from significant drawbacks and limitations. In an era focused on environmental protection and sustainability, there is potential for biodegradable polymers to replace non-degradable plastic materials to reduce environmental pollution and achieve sustainable development in resources, society, and the economy. With this in mind, this review aims to explore the concept and design of applying various natural biodegradable polymers like gelatin, chitosan, cellulose, etc., and synthetic biodegradable polymers like polylactic acid, poly(lactic-co-glycolic) acid, polycaprolactone, etc. for osteomyelitis treatment, including (1) replacing PMMA with biodegradable polymer beads, (2) biodegradable polymer coatings on medical implants, (3) injectable biodegradable polymer hydrogels, and (4) biodegradable polymers as scaffolds for osteogenic cell growth. This article contributes to understanding and advancing biodegradable polymer applications in biomedicine through a comprehensive review and discussion of these four aspects.