Targeting the biofilm microenvironment: Advances in stimuli-responsive antibacterial coating strategies for implant-associated infections
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Targeting the biofilm microenvironment: Advances in stimuli-responsive antibacterial coating strategies for implant-associated infections

Hanrong Xia
#
,
Xingzhou Wei
#
,
Chenyang Jin
#
,
Tong Jin
,
Miao Chen
,
Zhaobin Rao
,
Wei Wang
*
,
Dechun Geng
*
,
Jun Zhou
*
*Correspondence to: Wei Wang, Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu 215006, Suzhou, China. E-mail: gkww1995@163.com
Dechun Geng, Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu 215006, Suzhou, China. E-mail: szgengdc@163.com
Jun Zhou, Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Jiangsu 215006, Suzhou, China. E-mail: royf1@163.com
BME Horiz. 2026;4:202618. 10.70401/bmeh.2026.0033
Received: March 31, 2026Accepted: August 24, 2026Published: August 24, 2026
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This manuscript is made available in its unedited form to allow early access to the reported findings. Further editing will be completed before final publication. As such, the content may include errors, and standard legal disclaimers are applicable.

Abstract

As the global population ages, the prevalence of age-related conditions such as osteoporosis continues to increase, leading to greater use of orthopedic implants. However, implant-associated infections can cause severe complications, including loss of implant function, limb sequelae, and increased mortality. Biofilm formation is a major contributor to persistent implant-associated infection. Although biofilm formation and treatment strategies are increasingly understood, conventional approaches remain limited by delayed action, drug resistance, and off-target effects. Intelligent stimuli-responsive materials that react to pathological microenvironments or externally applied stimuli therefore have considerable potential for implant-related applications. This review first outlines the mechanisms of biofilm formation and current treatment strategies, with emphasis on their advantages and limitations. We then summarize advances in stimuli-responsive antibiofilm materials in orthopedics and related fields. Finally, we discuss the remaining obstacles that must be addressed before implantable stimuli-responsive systems can effectively target the biofilm microenvironment and progress toward clinical translation.

Keywords

Stimuli-responsive materials, antibacterial, biofilms, implants, infection

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Xia H, Wei X, Jin C, Jin T, Chen M, Rao Z, et al. Targeting the biofilm microenvironment: Advances in stimuli-responsive antibacterial coating strategies for implant-associated infections. BME Horiz. 2026;4:202618. https://doi.org/10.70401/bmeh.2026.0033

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