Current and Emerging Antibacterial Strategies to Control Periprosthetic Joint Infection

Julietta V. Rau1 and Iulian Antoniac 2,3

1Istituto di Struttura Della Materia, Consiglio Nazionale Delle Ricerche, Via del Fosso del Cavaliere 100, 00133 Rome, Italy; giulietta.rau@artov.ism.cnr.it

2Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania; iulian.antoniac@upb.ro

3Academy of Romanian Scientists, 54 Splaiul Independentei, RO-050094 Bucharest, Romania

Periprosthetic joint infection (PJI) is one of the most significant complications following joint arthroplasty, with serious clinical and economic implications. Biofilm formation on implant surfaces represents the key pathogenic mechanism, creating an environment that shields bacteria from host immunity and systemic antibiotics. Coupled with the rise of multidrug-resistant organisms, PJI presents significant therapeutic challenges.

Conventional strategies such as antibiotic-loaded bone cements, spacers, and beads have long been used to deliver antimicrobial drugs. Although these methods could provide high local concentration, they suffer from drawbacks including inconsistent release kinetics, limited biofilm penetration, and lack of biodegradability. These limitations highlight the need for next-generation solutions that offer reliable antimicrobial activity while supporting tissue regeneration.

Recent advances in biomaterials research offer promising alternatives. Multifunctional biomimetic materials, bioresorbable metal alloys, and nanocomposites are designed to release antimicrobial metal ions in a controlled manner. Coated bioresorbable metal alloys, such as magnesium or zinc, combine gradual degradation with antibacterial ion release and favorable mechanical properties. Biomimetic scaffolds inspired by bone architecture not only resist bacterial adhesion but also promote osteogenesis and vascularization, addressing infection control and regeneration simultaneously.

Surface modification techniques can reduce bacterial adhesion. For this purpose, antibacterial ion calcium phosphate coatings are being investigated for their ability to create long-lasting antibacterial surfaces without compromising host cell attachment and proliferation.

Preclinical models and early clinical studies indicate that combining antibacterial functionality with biocompatibility is achievable, but large-scale validation remains necessary.

The future of PJI management lies in multifunctional biomaterials that integrate infection prevention with regenerative potential. Next-generation materials capable of simultaneously controlling infection, supporting bone healing, and ensuring long-term implant integration could significantly reduce the PJI and improve the longevity and quality of joint replacements.