Advances in the Application of Multimodal Nano-Antimicrobial Strategies in Prosthetic Joint Infections: A Systematic Review.

Background: Prosthetic joint infection (PJI), a severe complication following total joint arthroplasty, is characterized by prolonged treatment duration, high costs, and poor outcomes. Current clinical treatment which typically relies on the use of antibiotic-loaded bone cement (ALBC) is limited by the generalization of bacterial resistance and the inherent defects of bone cement. Advancements in nanotechnology have led to nanomaterials and nanocoatings that offer promising alternative strategies, showing great potential for the prevention and management of PJI. This review aims to summarize the applications of nanotechnology in preventing and treating PJI following total joint arthroplasty and further discuss current advances and future perspectives in this field. Methods: PubMed, Web of Science, Scopus and Embase were searched for relevant studies covering the period from their inception to June 12, 2025. After removal of duplicate records, studies were excluded based on their abstract and title. The remaining studies were assessed for eligibility based on their full-text content. Conclusion: Nanotechnology has emerged as a highly promising alternative strategy against PJI. The current research frontiers encompass not only the development of stimulus-responsive nanomaterials for precise antibacterial control but also exploring their integration with targeted therapies, immunotherapy, and piezoelectric-based therapy.