Electrolytic cleaning as a biofilm control strategy on medical implants: mechanisms, evidence and translational...

Biofilm formation on medical devices represents a critical challenge in microbiology and clinical practice, as structured bacterial communities embedded in an extracellular polymeric matrix exhibit marked tolerance to antimicrobial agents and host defenses. In orthopedic implant-associated infections, these properties significantly limit the efficacy of conventional strategies based on surgical debridement and systemic antibiotic therapy, particularly when biofilm is established on metallic surfaces. Electrical-based approaches have been investigated as alternative strategies to target biofilm, including the application of electric fields and direct electrical currents. These methods influence bacterial viability and biofilm integrity mainly through electrochemical mechanisms, such as local pH changes and the generation of reactive species. However, their mechanisms remain heterogeneous and clinical translation has been limited. Electrolytic cleaning represents a distinct mechanistic paradigm based on water electrolysis at the solid-liquid interface. Hydrogen evolution at the cathode leads to gas bubble formation, which can exert mechanical forces on the biofilm structure and promote detachment from the underlying surface. This bubble-mediated mechanism provides a complementary physical approach to biofilm disruption. This minireview summarizes the physicochemical basis of water electrolysis and critically analyses the available experimental evidence. Although current data remain largely preclinical, the recent development of medical devices based on this technology suggests that clinical translation may be increasingly feasible. Nevertheless, robust evidence in patients is still lacking, and further studies are required to define safety, efficacy and optimal application parameters in clinically relevant settings.