Titanium for Orthopedic Applications: An Overview of Surface Modification to Improve Biocompatibility and Prevent Bacterial Biofilm Formation

Titanium and its alloys have emerged as excellent candidates for use as orthopedic biomaterials. Nevertheless, there are often complications arising after implantation of orthopedic 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 orthopedic 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 orthopedic 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.