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Farahini H, Safaee O. Biofilm-associated Orthopaedic Implant Infections and Periprosthetic Bone Loss: A Mini Narrative Review. JROS 2026; 13 (3) :99-106
URL: http://jros.iums.ac.ir/article-1-2331-en.html

Orthopaedic implant-associated infections, including periprosthetic joint infection (PJI) and fracture-related infection, remain formidable challenges due to the resilient nature of microbial biofilms. Biofilms facilitate bacterial persistence by providing phenotypic tolerance to antibiotics and shielding pathogens from host immune clearance, often leading to diagnostic ambiguities and high recurrence rates. This mini-review synthesizes current evidence on biofilm biology and management, contrasting established surgical strategies (debridement, antibiotics, and implant retention vs revision) and local antimicrobial delivery with emerging adjunctive therapies, such as bacteriophages, antimicrobial peptides, and photodynamic therapy (PDT). Furthermore, it delineates the molecular divergence between infection-associated periprosthetic bone loss and aseptic wear-particle osteolysis, highlighting the roles of receptor activator of nuclear factor-κB ligand/receptor activator of nuclear factor-κB/osteoprotegerin, nuclear factor kappa B, and mitogen-activated protein kinase signaling. While preclinical innovations show promise, the transition to clinical practice requires standardized diagnostic frameworks and robust prospective trials.