Evidence brief
Biofilm Formation on Orthopaedic Implants
Bacteria adhere to implant surfaces forming biofilm
Biofilm protects bacteria from antibiotics and immune system
Glycocalyx matrix is key protective structure
Eradication requires implant removal or disruption
Explains chronicity of implant infections
Biofilm biology explains why implant-related infections are difficult to treat with antibiotics alone and often require implant removal.
Understand biofilm formation stages: attachment, colonization, maturation, dispersal. Clinical implications: importance of prophylaxis, need for implant removal in chronic infection, role of DAIR in acute infection (<3 weeks). Antibiotic penetration into biofilm poor.
Level III
Retrospective comparative study or case-control study