Titanium for orthopaedic applications: an overview of surface modification to improve biocompatibility and prevent bacterial biofilm formation

Summary Titanium and its alloys have emerged as excellent candidates for use as orthopaedic biomaterials. Nevertheless, there are often complications arsing after implantation of orthopaedic devices; most notably prosthetic joint infection and aseptic loosening. To ensure that implanted devices remain functional in situ, innovation in surface modification has attracted much attention in the effort to develop orthopaedic materials with optimal characteristics at the biomaterial-tissue interface. This review will draw together metallurgy, surface engineering, biofilm microbiology and biomaterial science. It will serve to appreciate why titanium and its alloys are frequently used orthopaedic biomaterials, and address some of the challenges facing these biomaterials currently, including the significant problem of device associated infection. Finally, the authors shall consolidate and evaluate surface modification techniques employed to overcome some of these issues by offering a unique perspective as to the direction in which research is headed from a broad, interdisciplinary point of view.