Orthopaedic implant-related Infections: the scourge of the biofilms

The consequence of postoperative infections associated with orthopaedic or biomaterial-associated implants is devastating to both the patients and the surgeons. Bacterial microcolonies adhere to the surface of implants, forming biofilms and then detaching part of itself into free-floating planktonic forms may be the cause of recurrent and persistent infections. These bacteria are very resistant towards antibiotics and require a higher drug concentration than usual in order to eradicate them. Quorem-sensing is regarded as one mechanism of communication or integration between these microorganisms in the biofilm and may even be in the transfer of resistant genes. Disruption of this pathway is regarded as one method of inhibiting its growth and formation. Implant design, technique and stability of fixation as well as the surface characteristics, the material and its biocompatibility may also influence bacterial adhesion. It has been suggested that multi-prong strategies such as prevention and disruption of biofilm formation, parenteral antibiotics, use of antibiotic-impregnated construction materials and altering the intrinsic properties of the implant surface may help to eradicate this menace