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Infections in orthopaedic surgery are a serious issue. Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, many issues are still unclear or controversial: bacterial adhesion and antibiotic resistance, modification of mechanical properties which follows the addition of the antibiotic, factors influencing the release of the antibiotic from the cement and the role of the surface, the method for mixing the cement and the antibiotic, the choice and the effectiveness of the antibiotic, the combination of two or more antibiotics, and the toxicity. This review discusses all these topics, focusing on properties, merits, and defects of the antibiotic loaded cement. The final objective is to provide the orthopaedic surgeons clear and concise information for the correct choice of cement in their clinical practice.

Titanium and its alloys represent the gold standard for orthopaedic and dental prosthetic devices, because of their good mechanical properties and biocompatibility. Recent research has been focused on surface treatments designed to promote their rapid osteointegration also in case of poor bone quality. A new surface treatment has been investigated in this research work, in order to improve tissue integration of titanium based implants. The surface treatment is able to induce a bioactive behaviour, without the introduction of a coating, and preserving mechanical properties of Ti6Al4V substrates (fatigue resistance). The application of the proposed technique results in a complex surface topography, characterized by the combination of a micro-roughness and a nanotexture, which can be coupled with the conventional macro-roughness induced by blasting. Modified metallic surfaces are rich in hydroxyls groups: this feature is extremely important for inorganic bioactivity (in vitro and in vivo apatite precipitation) and also for further functionalization procedures (grafting of biomolecules). Modified Ti6Al4V induced hydroxyapatite precipitation after 15 days soaking in simulated body fluid (SBF). The process was optimised in order to not induce cracks or damages on the surface. The surface oxide layer presents high scratch resistance.

Bioactive and antibacterial coatings on stainless steel substrates were developed and characterized in this study. Silver nanocluster-silica composite coatings of 60-150 nm thickness were deposited using radio frequency (RF) co-sputtering on PEEK/bioactive glass (BG) layers (of 80-90 μm thickness) which had been electrophoretically deposited onto stainless steel. Two sputtering conditions were used by varying the deposition time (15 and 40 min); the resulting microstructure, composition, adhesion strength, in vitro bioactivity, and antibacterial activity were investigated. Scanning electron microscopy (SEM), X-ray photoelectron spectroscopy (XPS), and energy dispersive spectroscopy (EDX) confirmed the presence of silver nanoclusters, which were homogeneously embedded in the silica matrix. The isoelectric point of the coatings and their charge at physiological pH were determined by zeta potential measurements. The presence of BG particles in the PEEK/BG layer allows the coatings to form apatite-like crystals upon immersion in simulated body fluid (SBF). Moreover, silver nanoclusters embedded in the silica matrix as a top layer provided an antibacterial effect against Escherichia coli and Staphylococcus carnosus.

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