Advances in metallic biomaterial-based osteomyelitis theranostics

The treatment of osteomyelitis, a common orthopedic infection, presents a significant challenge for clinicians. The conventional approach to treating osteomyelitis involves prolonged and high-dose antibiotic therapy along with multiple surgical debridements; however, it is plagued by inadequate therapeutic efficacy and frequent re-sensitization. Therefore, the development of biomaterials possessing localized healing and antibacterial properties is imperative. In recent years, metal-based biomaterials have emerged as a hot research topic in the management of osteomyelitis due to their inherent antibacterial and bactericidal characteristics. This article provides an overview of the benefits and applications of metal-based biomaterials in treating osteomyelitis, encompassing magnesium-based, iron-based, copper-based, and noble metal–based materials as well as other metallic biomaterials. Metal-based biomaterials exhibit remarkable potential for addressing osteomyelitis owing to their broad-spectrum antibacterial properties, biodegradability, and ability to promote the proliferation of osteoblasts. Furthermore, these materials are gradually being employed in various biomedical therapies such as sonodynamic therapy, microwave dynamic therapy, photodynamic therapy immunotherapy, and multimodal therapy for effective treatment while circumventing the limitations associated with traditional antibiotic approaches. Metal-based biomaterials hold promising prospects for managing osteomyelitis effectively. Further research should focus on exploring solutions pertaining to challenges related to drug resistance, responsible drug release, and impact on mechanical properties of matrices induced by drugs, to facilitate clinical application of metal-based biomaterials in treating osteomyelitis.