Defensive antibacterial coating in orthopaedic surgery: Current evidence and future direction.

Periprosthetic joint infections contribute significantly to patient morbidity, prolonged hospital stays, and escalating healthcare costs. Defensive antibacterial coating (DAC) hydrogel has emerged as a promising strategy to combat these infections. It forms a biodegradable barrier that reduces bacterial adhesion and can deliver local antibiotics, thereby addressing a key mechanism in biofilm formation. Early clinical evidence suggests that DAC effectively lowers infection recurrence in revision hip and knee arthroplasties, with additional benefits in trauma procedures and soft tissue repairs. Moreover, it has demonstrated compatibility with existing implants and surgical techniques, while potentially reducing overall antibiotic use and hospital stays. Despite these encouraging findings, data for its use in primary arthroplasty remains limited, underscoring the need for large-scale, high-quality studies. Future research is poised to refine DAC's antimicrobial efficacy through novel antibiotic combinations, personalised delivery systems, and broader applications beyond lower limb procedures. As the prevalence of comorbidities continues to rise, DAC represents a valuable addition to multifaceted infection control protocols, potentially transforming orthopaedic care by enhancing patient outcomes and mitigating the economic and clinical burden of implant-related infections.