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REVIEW

Nanotechnology strategies for preventing early-stage implant- and fracture-related infections: Focus on periprosthetic joint infections, peri-implantitis, and osteomyelitis

Tharalamini Piumnil Gamagedara1* ,  Rathnayaka Liyanaarachchige Kalpana Madushani2 ,  Nawurunnege Sumeda Madhuranga1 ,  Herath Mudiyanselage Chandana Herath3
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1 Department of Basic Sciences, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central Province, Sri Lanka
2 Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central Province, Sri Lanka
3 Department of Orthopaedic Surgery, Teaching Hospital Peradeniya, Peradeniya, Central Province, Sri Lanka
BMT, 211 https://doi.org/10.12336/bmt.25.00211
Submitted: 27 October 2025 | Revised: 10 April 2026 | Accepted: 22 April 2026 | Published: 5 June 2026
© 2026 by the Author(s). Licensee Biomaterials Translational, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 (CC BY-NC-SA 4.0) (https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en)
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Abstract

Implant-related infections, including periprosthetic joint infections (PJIs), peri-implantitis, and fracture-related infections (FRIs), remain major clinical challenges, as conventional antibiotics and surgical interventions are limited by bacterial adhesion, biofilm formation, and complex host immune responses. These conditions differ in anatomical location, microbial ecology, and pathological progression, necessitating disease-specific prevention and treatment strategies. Nanotechnology offers promising solutions by enabling the design of multifunctional biomaterials that integrate antibacterial, immunomodulatory, and osteogenic properties. Zero-, one-, two-, and three-dimensional nanomaterials, including silver, zinc oxide, hydroxyapatite, chitosan, mesoporous silica, and lipid-based carriers, have demonstrated efficacy in antibiofilm activity, controlled drug delivery, and bone regeneration. Their antimicrobial effects arise from multiple synergistic mechanisms, including reactive oxygen species generation, ion-mediated toxicity, membrane disruption, and inhibition of biofilm formation, thereby enhancing effectiveness against resistant pathogens. In addition to direct antibacterial action, emerging nanoplatforms modulate host immune responses and promote tissue integration, underscoring the importance of host– pathogen–material interactions in therapeutic outcomes. Advanced designs, including hybrid and stimulus-responsive systems, further enhance treatment efficacy while minimizing cytotoxicity and resistance development. Although challenges such as long-term biocompatibility and stability in clinical translation remain, biodegradable multifunctional nanomaterials represent a paradigm shift in implant-associated infection management. This review provides a disease-oriented, mechanism-driven overview of nanotechnology-based strategies for PJIs, peri-implantitis, and FRIs, critically evaluating their advantages, limitations, and translational potential in preventing infection, supporting tissue regeneration, and reducing the risk of osteomyelitis.

Keywords
Nanotechnology
Implant-related infections
Fracture-related infections
Biofilm inhibition
Drug delivery
Immunomodulation
Bone regeneration
Osteomyelitis
Funding
None.
Conflict of interest
The authors declare no conflicts of interest.
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