Antibacterial Hydrogel Coating of Implants in Orthopedics and Trauma: Surgical Technique and Clinical Applications

Background: Implant-associated infections and subsequent biofilm formation remain primary causes of orthopedic surgery failure, affecting up to 80% of bacterial infections and resulting in significant socioeconomic burdens. Bacterial colonization typically occurs within hours of implantation, creating a protective intercellular matrix that resists systemic antimicrobial therapy and host immune responses.

Objective: This article describes the surgical application, technical specifications, and clinical outcomes of a fast-resorbable, hyaluronic acid-based hydrogel coating designed to prevent bacterial adhesion on orthopedic and trauma implants.

Key Points: The Defensive Antibacterial Coating (DAC®) consists of hyaluronic acid grafted to polylactic acid. This biocompatible hydrogel acts as a physical barrier against microbial colonization and can be intraoperatively loaded with antibiotics, such as vancomycin or meropenem, at concentrations of 2% to 5%. The coating is compatible with various biomaterials, including titanium, cobalt-chrome, and polyethylene, and retains 60% to 80% adherence following press-fit insertion. Clinical data from 724 patients indicate an eightfold reduction in early post-surgical infections compared to uncoated controls. No adverse effects on bone healing, osseointegration, or systemic laboratory markers have been reported. The hydrogel undergoes complete resorption within 72 hours, coinciding with the window of maximum infection risk.

Conclusion: The application of a resorbable, antibiotic-loaded hydrogel provides a versatile and safe method for reducing peri-prosthetic and fracture-related infections. This technology effectively bridges the gap between initial implantation and host tissue integration by inhibiting early biofilm formation without compromising long-term implant stability.