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Biofilms—What Should the Orthopedic Surgeon know?

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  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

Musculoskeletal infections are a major source of morbidity for orthopedic and trauma patients, are associated with prolonged treatment times, and, unfortunately, suffer from poor functional outcomes. Further complicating the issue, antimicrobial resistance (AMR) is increasingly impacting the treatment of musculoskeletal infections with a diminishing repertoire of effective antibiotic agents for some highly resistant pathogens. Most orthopedic surgical procedures involve implants, and the formation of bacterial biofilms on these implants is now recognized as a major factor contributing to the failure of antibiotic therapy in orthopedic surgery.

Methods

This review presents an overview of the types, structure, formation, and pathogenesis of biofilms as they pertain to musculoskeletal infections. Furthermore, it describes the key concepts in the management of biofilms and future perspectives for the better treatment of patients with biofilm-related musculoskeletal infections.

Results

A bacterial biofilm is a dynamic, living conglomerate of bacteria encased in an extracapsular polysaccharide matrix (EPS). Biofilms are a natural mode of survival for virtually all bacterial species, including both Grampositive and Gram-negative bacteria, as well as fungi. The biofilm model of growth confers resistance by several well-defined mechanisms regardless of the species of the microorganism. In most cases, biofilm management often necessitates radical measures to ensure eradication including both surgical and medical interventions.

Conclusions

Orthopedic surgeons should be aware of the key concepts pertaining to biofilms, and the impact that these can have on clinical practice.

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Funding

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Author information

Authors and Affiliations

  1. Foot & Ankle Biomechanics, Experimentation and Research Laboratory, Department of Orthopedics, Postgraduate Institute of Medical Education & Research, Chandigarh, India

    Mandeep Singh Dhillon & Siddhartha Sharma

  2. Department of Emergency Medicine (Orthopedics), Ambedkar Institute of Medical Sciences, Mohali, Punjab, India

    Aman Hooda

  3. Infection Biology, AO Research Institute, Davos, Switzerland

    Thomas Fintan Moriarty

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  1. Mandeep Singh Dhillon
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  2. Aman Hooda
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  3. Thomas Fintan Moriarty
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  4. Siddhartha Sharma
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Correspondence to Siddhartha Sharma.

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Communicated by Dr. Vikas Agashe.

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Dhillon, M.S., Hooda, A., Moriarty, T.F. et al. Biofilms—What Should the Orthopedic Surgeon know?. JOIO 57, 44–51 (2023). https://doi.org/10.1007/s43465-022-00782-6

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