Orthopaedic and dental implants have become a staple of the medical industry and with an ageing population and growing culture for active lifestyles, this trend is forecast to continue. In accordance with the increased demand for implants, failure rates, particularly those caused by bacterial infection, need to be reduced. The past two decades have led to developments in antibiotics and antibacterial coatings to reduce revision surgery and death rates caused by infection. The limited effectiveness of these approaches has spurred research into nano-textured surfaces, designed to mimic the bactericidal properties of some animal, plant and insect species, and their topographical features. This review discusses the surface structures of cicada, dragonfly and butterfly wings, shark skin, gecko feet, taro and lotus leaves, emphasising the relationship between nano-structures and high surface contact angles on self-cleaning and bactericidal properties. Comparison of these surfaces shows large variations in structure dimension and configuration, indicating that there is no one particular surface structure that exhibits bactericidal behaviour against all types of microorganisms. Recent bio-mimicking fabrication methods are explored, finding hydrothermal synthesis to be the most commonly used technique, due to its environmentally friendly nature and relative simplicity compared to other methods. In addition, current proposed bactericidal mechanisms between bacteria cells and nano-textured surfaces are presented and discussed. These models could be improved by including additional parameters such as biological cell membrane properties, adhesion forces, bacteria dynamics and nano-structure mechanical properties. This paper lastly reviews the mechanical stability and cytotoxicity of micro and nano-structures and materials. While the future of nano-biomaterials is promising, long-term effects of micro and nano-structures in the body must be established before nano-textures can be used on orthopaedic implant surfaces as way of inhibiting bacterial adhesion.

Implant failure is a common problem in orthopedic applications, which causes pain and stress for patients, prolonged antibiotic therapy, increased time and cost of hospitalization, and revision surgery. Selecting the optimum porous structure, manufacturing process and surface modification approach is crucial to reduce the rate of implant failure. The design of porous structures in orthopedic implants plays an important role in vascularization, diffusion of nutrients, and in the relationship between implants and osteoblasts. Common techniques for porous design are computer aided design (CAD), image based design, implicit surface design, and topology optimization. Metal-based additive manufacturing methods such as electron beam melting (EBM), selective laser melting (SLM) and selective laser sintering (SLS) have been extensively developed for fabrication of porous structures on Titanium. Several chemical surface modification methods are used, such as acid etching, anodization, and coatings, to improve mechanical properties, biocompatibility, increase surface roughness, and to promote osseointegration and bone regrowth. This paper reviews the design and manufacturing of porous implant material via additive manufacturing techniques, as well as recent advances in surface modification, to achieve biocompatible surfaces. The outcome of this research will provide an effective strategy for manufacturing, and surface modification of titanium orthopedic implants

Orthopaedic surgery comes with an inherent risk of bacterial infection, prolonged antibiotic therapy and revision surgery. Recent research has focused on nanostructured surfaces to improve the bactericidal and osseointegrational properties of implants. However, an understanding of the mechanical properties of bactericidal materials is lacking. In this work, the surface properties of hydrothermal TiO₂ nanostructured surfaces are investigated for their effect on bactericidal efficiency and cellular metabolic activity of human osteoblast cells. TiO₂ nanostructures, approximately 307 nm in height and 14 GPa stiffness, were the most effective structures against both gram-positive (Staphylococcus aureus) and gram-negative (Pseudomonas aeruginosa) bacteria. Statistical analysis significantly correlated structure height to the death of both bacteria strains. In addition, the surface contact angle and Young’s modulus were correlated to osteoblast metabolic activity. Hydrophilic surfaces with a contact angle between 35 and 50° produced the highest cellular metabolic activity rates after 24 h of incubation. The mechanical tests showed that nanostructures retain their mechanical stability and integrity over a long time-period, reaffirming the surfaces’ applicability for implants. This work provides a thorough examination of the surface, mechanical and wettability properties of multifunctional hydrothermally synthesised nanostructured materials, capable of killing bacteria whilst improving osteoblast metabolic rates, leading to improved osseointegration and antibacterial properties of orthopaedic implants.

Nanopatterned surfaces administer antibacterial activity through contact-induced mechanical stresses and strains, which can be modulated by changing the nanopattern’s radius, spacing and height. However, due to conflicting recommendations throughout the theoretical literature with poor agreement to reported experimental trends, it remains unclear whether these key dimensions—particularly radius and spacing—should be increased or decreased to maximize bactericidal efficiency. It is shown here that a potential failure of biophysical models lies in neglecting any out-of-plane effects of nanopattern contact. To highlight this, stresses induced by a nanopattern were studied via an analytical model based on minimization of strain and adhesion energy. The in-plane (areal) and out-of-plane (contact pressure) stresses at equilibrium were derived, as well as a combined stress (von Mises), which comprises both. Contour plots were produced to illustrate which nanopatterns elicited the highest stresses over all combinations of tip radius between 0 and 100 nm and center spacing between 0 and 200 nm. Considering both the in-plane and out-of-plane stresses drastically transformed the contour plots from those when only in-plane stress was evaluated, clearly favoring small tipped, tightly packed nanopatterns. In addition, the effect of changes to radius and spacing in terms of the combined stress showed the best qualitative agreement with previous reported trends in killing efficiency. Together, the results affirm that the killing efficiency of a nanopattern can be maximized by simultaneous reduction in tip radius and increase in nanopattern packing ratio (i.e., radius/spacing). These findings provide a guide for the design of highly bactericidal nanopatterned surfaces.