Bioengineering methods for tailoring treatment of Osteomyelitis: Advancing strategies and application

Osteomyelitis (OM), an inflammatory disease of the bone due to pathogenic infection, represents one of the most significant challenges encountered by orthopedic surgeons worldwide. Under pathogenic, OM sites undergo persistent inflammation, oxidative stress, bone immune dysfunction, and abnormal osteocyte metabolism, resulting in recurrent bacterial infections and bone resorption. The curation of OM primarily relies on systematic high-dose antibiotics and local surgical debridement. Despite the discovery of various antimicrobial drugs in recent decades, there has been little clinical progress in OM eradication. The emergence of bioengineering materials offers great hope for addressing this issue. Beyond the antimicrobial activity, they often possess one or more of the following functions: antioxidant, anti-inflammatory, immunomodulatory, angiogenic and osteogenic. These materials have shown promising therapeutic effects in animal OM models. However, extensive and comprehensive animal studies and clinical trials are still needed to determine their direct and lasting impact on OM patients. This review integrates the complex microenvironmental characteristics of OM, delving into the construction principles and mechanisms of various bioengineering methods. It aims to enhance understanding of their suitability in meeting the therapeutic needs of OM. Additionally, it explores the clinical applicability and future prospects of multifunctional biomaterials in treating OM.