Preventing bacterial adhesion on scaffolds for bone tissue engineering

Bone implant infection constitutes a major sanitary concern which is associated to high morbidity and health cost. This manuscript focuses on overviewing the main research efforts committed up to date to develop innovative alternatives to conventional treatments, such as those with antibiotics. These strategies mainly rely on the chemical modification of the surface of biomaterials, such as providing them of zwitterionic nature, and tailoring the surface nanostructure of metal implants. These surface modifications have successfully allowed inhibiting bacterial adhesion, which is the first step of implant infection, and preventing long-term biofilm formation compared to pristine materials. These strategies could be easily applied to provide three-dimensional (3D) scaffolds based on bioceramics and metals, whose manufacture using rapid prototyping techniques is reviewed. This opens the gates for the design and development of advanced 3D scaffolds for bone tissue engineering that prevent bone implant infection.