Periprosthetic Joint Infection: Biofilm Pathogenesis, Immune Dysregulation, and Emerging Prosthetic Interface...

Area of Science:

• Biomaterials Science
• Infectious Diseases
• Orthopedic Surgery

Background:

• Periprosthetic joint infection (PJI) poses significant challenges post-arthroplasty, leading to complications like implant failure and functional decline.
• Current treatments are limited by biofilm resistance, poor drug penetration, and impaired bone repair, highlighting PJI as a complex prosthetic interface disorder.

Purpose of the Study:

• To review recent advancements in anti-infective prosthetic interface design for managing PJI.
• To emphasize the shift towards multifunctional systems integrating antibacterial, immunomodulatory, and osseointegrative properties.

Main Methods:

• Discussion of the pathogenic mechanisms of PJI, including biofilm formation and immune dysregulation.
• Evaluation of current clinical management limitations and emerging biomaterial strategies.
• Focus on balancing antibacterial efficacy with cytocompatibility, immune resolution, and osseointegration.

Main Results:

• Emerging strategies include anti-adhesive surfaces, active antimicrobial coatings, biofilm disruption, and smart delivery systems.
• Osteoimmunomodulatory interfaces are crucial for managing inflammation and promoting bone repair.
• Balancing early antibacterial action with long-term osseointegration and mechanical integrity is key.

Conclusions:

• Future anti-PJI interfaces must be stage-specific, integrating biofilm control, immune restoration, and bone regeneration.
• Overcoming translational barriers like material durability, standardized models, and regulatory hurdles is essential for clinical readiness.
• The evolution towards smart, multifunctional interfaces promises improved management of PJI and better patient outcomes.