Nanotechnology-based strategies in orthopaedic surgery: implications for osseointegration, infection prevention and bone regeneration

Abstract

Orthopaedic surgery continues to face challenges related to delayed bone healing, implant loosening, and implant-associated infection, despite advances in surgical techniques and biomaterials. Conventional implant materials are primarily mechanically reliable but biologically passive, limiting their ability to promote osseointegration or actively resist bacterial colonization. Nanotechnology has emerged as a promising strategy to enhance biological performance at the bone–implant interface by modifying material properties at the nanoscale. A systematic review was conducted to synthesise experimental, translational, and early clinical evidence on nanotechnology-based applications in orthopaedic surgery. A structured literature search was conducted using PubMed, Google Scholar, and Web of Science for studies published between 2015 and 2025. Evidence was thematically analysed and organized into three domains: nanostructured implant surfaces and osseointegration, antimicrobial nanocoatings for infection prevention, and nanofibrous or nanocomposite scaffolds for bone regeneration. Across the reviewed studies, nanoscale surface modifications consistently demonstrated enhanced osteoblast adhesion, early mineralization, and increased bone–implant contact compared with conventional surfaces. Antimicrobial nanocoatings and nanoparticle-based delivery systems showed effective local inhibition of bacterial adhesion and biofilm formation while maintaining cytocompatibility. Nanofibrous and nanocomposite scaffolds that mimic the native bone extracellular matrix support cellular infiltration, osteogenic differentiation, and mineral deposition in preclinical models. However, most available evidence remains preclinical or early translational. Nanotechnology-enabled strategies offer promising biological advantages for enhancing osseointegration, reducing implant-related infections, and promoting bone regeneration in orthopaedic surgery. While current findings support their potential clinical value, widespread adoption is limited by the lack of large-scale clinical trials, long-term safety data, and standardised regulatory pathways. Further high-quality clinical studies are required to validate these technologies and define their role in routine orthopaedic practice.