Biomaterial-Based Scaffolds as Carriers of Topical Antimicrobials for Bone Infection Prophylaxis

In recent years, several modern therapies in orthopedics have been introduced, and these have been significantly influenced by the development of innovative medical devices made from various biomaterials. All orthopedic procedures involving the use of medical devices can lead to the occurrence of postoperative infectious complications, generally referred to as biomaterial-associated infections (BAIs). Currently, the classical antimicrobial treatment of BAIs consists mainly of systemic antibiotic therapy, which does not provide adequate clinical efficacy and is associated with the risk of many adverse effects. Therefore, numerous studies have been conducted to develop various methods to limit BAIs locally. Most of them involve the development of bioactive coatings or modified surfaces of biomaterials capable of releasing various antimicrobial substances. Applying such solutions in bone surgery is primarily related to the anti-infective protection of bone scaffolds, which is currently one of the most advanced and promising techniques in regenerative medicine. Using scaffolds in the damaged tissue provides an artificial structure that supports cell growth in the appropriate spatial configuration and restores the mechanical properties of the damaged bone in a short time. Therefore, the long-term protection of bone scaffolds against infection is crucial for achieving complete therapeutic success and currently represents one of the most significant challenges in bone surgery. This article presents selected strategies for modifying bone scaffolds that have been developed to reduce the risk of BAI.