Introduction: Implant-associated
infections are a major problem in orthopaedic surgery. Local delivery systems of
antimicrobial agents on the implant surface have attracted great interest recently. The purpose of this study was to identify antimicrobial coatings currently used in clinical practice, examining their safety and effectiveness in reducing post-operative
infection rates. Materials and Methods: A systematic review was conducted in four databases (Medline, Embase, Cochrane, Cinahl) according to the Preferred Reporting Items for Systematic reviews and Meta-analysis (
PRISMA) guidelines up to December 2019, using the key words "orthopaedic implant coated", "coated implant
infection", "
silver coating " and "
antibiotic coating". Results: Seven articles involving 1307 patients (561 with coated implants and 746 controls who were not) comparing the incidence of periprosthetic
infections after the application of
internal fracture fixation, total
arthroplasties and
endoprostheses were evaluated. Three different coating technologies were identified:
gentamicin coating for tibia nail and total
arthroplasties;
silver technology and
povidone-iodine coating for tumour
endoprostheses and
titanium implants. Meta-analysis demonstrated that patients who were treated with antimicrobial coated implants presented lower
infection rates compared to controls over the seven studies (Q = 6.1232, I2 = 0.00, 95% CI: 1.717 to 4.986, OR: 2.926, Z= 3.949, p<0.001). Subgroup statistical analysis revealed that each coating technique was effective in the prevention of periprosthetic
infections (Q = 9.2606, I2 = 78.40%, 95% CI: 1.401 to 4.070, OR: 2.388, Z= 3.200, p<0.001). Conclusion: All technologies were reported to have good biocompatibility and were effective in the reduction of post-operative peri-prosthetic
infection rates.