Electrophoretic deposition: a versatile tool against biomaterial associated infections

Biomaterial-associated infections (BAIs) are today considered as one of the most withering complications of orthopedic implant surgery. Even though BAIs occur relatively infrequently in primary joint replacement surgeries (incidence rates around 1-2%), revision arthroplasties carry up to 40% risk of infection recurrence, with devastating consequences for the patient and significant associated cost. Once the responsible pathogens, mainly bacteria, attach to the surface of the biomaterial, they start creating layers of extracellular matrix with complex architectures, called biofilms. These last mentioned, encapsulate and protect bacteria by hindering the immune response and impeding antibiotics from reaching the pathogens. To prevent such an outcome, the surface of the biomaterials, in particular implants, can be modified in order to play the role of inherent drug delivery devices or as substrates for antibacterial/multifunctional coating deposition. This paper presents an overview of novel electrochemically-triggered deposition strategies, with a focus on electrophoretic deposition (EPD), a versatile and cost-effective technique for organic and inorganic material deposition. Other than being a simple deposition tool, EPD has been recently employed to create novel micro/nanostructured surfaces for multi-purpose antibacterial approaches, presented in detail in this review. In addition, a thorough comparison and assessment of the latest antibacterial and multifunctional compounds deposited by means of EPD have been reported, followed by a critical reflection on current and future prospects of the topic. The relative simplicity of EPD's application, has, by some means, undermined the fundamental requirement of rationality of multifunctional coating design. The demanding practical needs for a successful clinical translation in the growing fields of tissue engineering and antibacterial/multifunctional implant coatings, calls for a more systematic in vitro experimental design rationale, in order to make amends for the scarcity of significant in vivo and clinical studies.