Recent Developments in Coatings for Orthopedic Metallic Implants

A numerical investigation for the development of functionally graded Ti/HA tibial implant for total ankle replacement: Influence of material gradation law and volume fraction index

Stress shielding is one of the major concerns for total ankle replacement implants nowadays, because it is responsible for implant-induced bone resorption. The bone resorption contributes to the aseptic loosening and failure of ankle implants in later stages. To reduce the stress shielding, improvements can be made in the implant material by decreasing the elastic mismatch between the implant and the tibia bone. This study proposes a new functionally graded material (FGM) based tibial implant for minimizing the problem of stress shielding. Three-dimensional finite element (FE) models of the intact tibia and the implanted tibiae were created to study the influence of material gradation law and volume fraction index on stress shielding and implant-bone micromotion. Different implant materials were considered that is, cobalt-chromium, titanium (Ti), and FGM with Ti at the bottom and hydroxyapatite (HA) at the top. The FE models of FGM implants were generated by using different volume fractions and the rule of mixtures. The rule of mixtures was used to calculate the FGM properties based on the local volume fraction. The volume fraction was defined by using exponential, power, and sigmoid laws. For the power and sigmoid law varying volume fraction indices (0.1, 0.2, 0.5, 1, 2, and 5) were considered. The geometry resembling STAR® ankle system tibial implant was considered for the present study. The results indicate that FGMs lower stress shielding but also marginally increase implant-bone micromotion; however, the values were within the acceptable limit for bone ingrowth. It is observed that the material gradation law and volume fraction index influence the performance of FGM tibial implants. The tibial implant composed of FGM using power law with a volume fraction index of 0.1 was the preferred option because it showed the least stress shielding.

In Vivo Biocompatibility Study on Functional Nanostructures Containing Bioactive Glass and Plant Extracts for Implantology

In this paper, the in vivo behavior of orthopedic implants covered with thin films obtained by matrix-assisted pulsed laser evaporation and containing bioactive glass, a polymer, and natural plant extract was evaluated. In vivo testing was performed by carrying out a study on guinea pigs who had coated metallic screws inserted in them and also controls, following the regulations of European laws regarding the use of animals in scientific studies. After 26 weeks from implantation, the guinea pigs were subjected to X-ray analyses to observe the evolution of osteointegration over time; the guinea pigs' blood was collected for the detection of enzymatic activity and to measure values for urea, creatinine, blood glucose, alkaline phosphatase, pancreatic amylase, total protein, and glutamate pyruvate transaminase to see the extent to which the body was affected by the introduction of the implant. Moreover, a histopathological assessment of the following vital organs was carried out: heart, brain, liver, and spleen. We also assessed implanted bone with adjacent tissue. Our studies did not find significant variations in biochemical and histological results compared to the control group or significant adverse effects caused by the implant coating in terms of tissue compatibility, inflammatory reactions, and systemic effects.

Development of bioactive and antimicrobial nano-topography over selective laser melted Ti6Al4V implant and its in-vitro corrosion behavior

Additive manufacturing (AM) or 3D printing of bone defect models is gaining much attention in the biomedical field as it could significantly facilitate the development of customized implants with a high degree of dimensional accuracy. Due to their satisfactory biocompatibility and minimal stress shielding effect, Ti6Al4V (Ti64) alloys are increasingly preferred in the development of such implants. However, their poor osseointegration abilities and lack of antibacterial properties often cause implant loosening and microbial infections, leading to implant failure. To address these drawbacks, we propose in this work a simple surface modification approach of customized Ti64 alloys (3D printed Ti6Al4V) that enables the formation of porous calcium titanate (CT) over their surface as well as the incorporation of silver nanoparticles (AgNPs) into the thus formed porous network. The successful CT formation with the incorporation of AgNPs throughout the 3D printed Ti64 surface and their influence in changing the morphological and mechanical behaviour were studied by Raman spectroscopy, SEM, AFM, Contact angle measurement, XPS, HR-TEM and nano-indentation. Antibacterial studies using Staphylococcus aureus and Escherichia coli, and in-vitro cell studies using MG-63 cell lines showed that surface modified samples resulting from the proposed method exhibit satisfactory antimicrobial property and are highly biocompatible. The obtained surface modified samples also showed a significant improvement in corrosion resistance as compared to unmodified 3D printed Ti64 alloys. The improvement in corrosion resistance was revealed by electrochemical impedance Spectroscopy (EIS). Obtained results emphasis that thus surface modified 3D printed Ti64 alloys are promising candidates for hard tissue implant applications.

The role of stiffness-matching in avoiding stress shielding-induced bone loss and stress concentration-induced skeletal reconstruction device failure

It is well documented that overly stiff skeletal replacement and fixation devices may fail and require revision surgery. Recent attempts to better support healing and sustain healed bone have looked at stiffness-matching of these devices to the desired role of limiting the stress on fractured or engrafted bone to compressive loads and, after the reconstructed bone has healed, to ensure that reconstructive medical devices (implants) interrupt the normal loading pattern as little as possible. The mechanical performance of these devices can be optimized by adjusting their location, integration/fastening, material(s), geometry (external and internal), and surface properties. This review highlights recent research that focuses on the optimal design of skeletal reconstruction devices to perform during and after healing as the mechanical regime changes. Previous studies have considered auxetic materials, homogeneous or gradient (i.e., adaptive) porosity, surface modification to enhance device/bone integration, and choosing the device's attachment location to ensure good osseointegration and resilient load transduction. By combining some or all of these factors, device designers work hard to avoid problems brought about by unsustainable stress shielding or stress concentrations as a means of creating sustainable stress-strain relationships that best repair and sustain a surgically reconstructed skeletal site. STATEMENT OF SIGNIFICANCE: Although standard-of-care skeletal reconstruction devices will usually allow normal healing and improved comfort for the patient during normal activities, there may be significant disadvantages during long-term use. Stress shielding and stress concentration are amongst the most common causes of failure of a metallic device. This review highlights recent developments in devices for skeletal reconstruction that match the stiffness, while not interrupting the normal loading pattern of a healthy bone, and help to combat stress shielding and stress concentration. This review summarises various approaches to achieve stiffness-matching: application of materials with modulus close to that of the bone; adaptation of geometry with pre-defined mechanical properties; and/or surface modification that ensures good integration and proper load transfer to the bone.

Biomechanical Behavior of Dynamic vs. Static Distal Locking Intramedullary Nails in Subtrochanteric Femur Fractures

OBJECTIVE

Hip fractures are one of the most frequent fractures presenting to the emergency department and orthopedic trauma teams. The aim of this study was to determine the best indication and therapeutic technique for subtrochanteric fractures and unifying criteria when choosing the most suitable type of nail.

MATERIALS AND METHODS

To analyze the influence of the material and the type of distal locking of intramedullary nails (static or dynamic), a femur model with a fracture in the subtrochanteric region stabilized with a long Gamma intramedullary nail was applied using finite element method (FEM) simulation.

RESULTS

The mechanical study shows that titanium nails allow for greater micromobility at the fracture site, which could act as a stimulus for the formation of callus and consolidation of the fracture. In the mechanical study, the type of distal locking mainly affects mobility at the fracture site and stress in the cortical bone around the distal screws, without in any case exceeding values that may compromise the viability of the assembly or that may result in detrimental effects (in terms of mobility at the fracture site) for the consolidation process.

CONCLUSION

Subtrochanteric fractures treated with titanium nail and static distal locking is safe and does not hinder consolidation.

Fabrication and Characterization of a Multifunctional Coating to Promote the Osteogenic Properties of Orthopedic Implants

Titanium-based alloys are used in orthopedic applications as fixation elements, hard tissue replacements in artificial bones, and dental implants. Despite their wide range of applications, metallic implant defects and failures arise due to inadequate mechanical bonding, postoperative clotting problems, aseptic loosening, and infections. To improve the surface bioactivity and reduce the corrosion rate of the Ti6Al4V alloy, multi-layered coatings (HAp, BG, Cs, and Hep) were applied via electrophoretic deposition (EPD). XRD images showed the presence of HAp within the coating. In vitro investigation: cell line NIH-3T3 fibroblasts were seeded on the non-coated and coated Ti6Al4V substrates, and their cellular behavior was evaluated. The results indicated that the HApBGCsHep coating could enhance the adhesion and proliferation of NIH 3T3 cells. In addition, the potentiodynamic polarization results are compatible with the in vitro outcome.

Evaluation of polyetheretherketone composites modified by calcium silicate and carbon nanotubes for bone regeneration: mechanical properties, biomineralization and induction of osteoblasts

Desired orthopedic implant materials must have a good biological activity and possess appropriate mechanical property that correspond to those of human bone. Although polyetheretherketone (PEEK) has displayed a promising application prospect in musculoskeletal and dentistry reconstruction thanks to its non-biodegradability and good biocompatibility in the body, the poor osseointegration and insufficient mechanical strength have significantly limited its application in the repair of load-bearing bones and surgical operations. In this study, carbon nanotubes (CNT)/calcium silicate (CS)/polyetheretherketone ternary composites were fabricated for the first time. The addition of CS was mainly aimed at improving biological activities and surface hydrophilicity, but it inevitably compromised the mechanical strength of PEEK. CNT can reinforce the composites even when brittle CS was introduced and further upgraded the biocompatibility of PEEK. The CNT/CS/PEEK composites exhibited higher mechanical strengths in tensile and bending tests, 64% and 90% higher than those of brittle CS/PEEK binary composites. Besides, after incorporation of CNT and CS into PEEK, the hydrophilicity, surface roughness and ability to induce apatite-layer deposition were significantly enhanced. More importantly, the adhesion, proliferation, and osteogenic differentiation of mouse embryo osteoblasts were effectively promoted on CNT/CS/PEEK composites. In contrast to PEEK, these composites exhibited a more satisfactory biocompatibility and osteoinductive activity. Overall, these results demonstrate that ternary CNT/CS/PEEK composites have the potential to serve as a feasible substitute to conventional metal alloys in musculoskeletal regeneration and orthopedic implantation.

The effect of CNTs/PEEK coating thickness on the friction and wear behavior of porous Ti‐30Ta alloys for biomaterial implants

Electrophoretic deposition was used to deposit carbon nanotube/polyether ether ketone (CNTs/PEEK) composite coatings onto porous titanium‐tantalum (Ti‐30Ta) substrates at different PEEK concentrations (4.5, 6.0, and 7.5 mg/mL). Coatings were analyzed for thickness, porosity, surface roughness, microhardness and bonding strength, with higher PEEK concentrations producing thicker and more uniform coatings. However, optimal coating thickness showed highest bonding strength; lower and higher thickness led to decreased bonding strength. The tribological properties of the CNTs/PEEK coated Ti‐30Ta samples of different thicknesses (50, 70, and 100 μm) were evaluated using ball‐on‐flat linear reciprocating sliding tests under dry and wet conditions using simulated body fluid (SBF) as a lubricant. The CNTs/PEEK coatings provided excellent tribological protection under dry friction, with thicker coatings having lower friction and negligible wear. However, under wet sliding, the coating's wear rate increased significantly due to softening of the rubbing surface caused by SBF lubrication that increase transfer film onto the counter body surface. Coating with optimal thickness of 74 μm demonstrated the lowest friction and wear under SBF lubrication due to its highest hardness and bonding strength. This study highlights the importance of controlling coating thickness in determining the performance of the CNTs/PEEK coatings for orthopedic implants.

Antimicrobial and Biodegradable 3D Printed Scaffolds for Orthopedic Infections

In bone tissue engineering, the performance of scaffolds underpins the success of the healing of bone. Microbial infection is the most challenging issue for orthopedists. The application of scaffolds for healing bone defects is prone to microbial infection. To address this challenge, scaffolds with a desirable shape and significant mechanical, physical, and biological characteristics are crucial. 3D printing of antibacterial scaffolds with suitable mechanical strength and excellent biocompatibility is an appealing strategy to surmount issues of microbial infection. The spectacular progress in developing antimicrobial scaffolds, along with beneficial mechanical and biological properties, has sparked further research for possible clinical applications. Herein, the significance of antibacterial scaffolds designed by 3D, 4D, and 5D printing technologies for bone tissue engineering is critically investigated. Materials such as antibiotics, polymers, peptides, graphene, metals/ceramics/glass, and antibacterial coatings are used to impart the antimicrobial features for the 3D scaffolds. Polymeric or metallic biodegradable and antibacterial 3D-printed scaffolds in orthopedics disclose exceptional mechanical and degradation behavior, biocompatibility, osteogenesis, and long-term antibacterial efficiency. The commercialization aspect of antibacterial 3D-printed scaffolds and technical challenges are also discussed briefly. Finally, the discussion on the unmet demands and prevailing challenges for ideal scaffold materials for fighting against bone infections is included along with a highlight of emerging strategies in this field.

Evaluation of Physiochemical and Biological Properties of Biofunctionalized Mg-Based Implants Obtained via Large-Scale PEO Process for Dentistry Applications

An increasing number of tooth replacement procedures ending with implant failure generates a great need for the delivery of novel biomedical solutions with appropriate mechanical characteristics that would mimic natural tissue and undergo biodegradation. This phenomenon constitutes a significant difficulty for scientists, since currently applied biomaterials dedicated for this purpose are based on stainless steel, Ti, and Ti and CoCr alloys. One of the most promising raw materials is magnesium, which has been proven to promote bone regeneration and accelerate the tissue healing process. Nevertheless, its high reactivity with body fluid components is associated with fast and difficult-to-control biocorrosion, which strongly limits the application of Mg implants as medical devices. The achievement of appropriate functionality, both physiochemical and biological, to enable the commercial use of Mg biomaterials is possible only after their superficial modification. Therefore, the obtainment of uniform, reproducible coatings increasing resistance to the aqueous environment of the human body combined with a nanostructured surface that enhances implant-cell behaviors is an extremely important issue. Herein, we present a successful strategy for the modification of Mg implants via the PEO process, resulting in the obtainment of biomaterials with lower corrosion rates and superior biological properties, such as the promotion of extracellular matrix formation and a positive impact on the proliferation of MG-63 cells. The implants were investigated regarding their chemical composition using the FT-IR and XRD methods, which revealed that MgO layer formation, as well as the incorporation of electrolyte components such as fluorine and silica, were responsible for the increased microhardness of the samples. An extensive study of the biomaterials' morphology confirmed that successful surface modification led to a microporous structure suitable for the attachment and proliferation of cells. The three-layer nature of the newly-formed coatings, typical for PEO modification, was confirmed via cross-section analysis. A biocorrosion and biodegradation study proved that applied modification increased their resistance to body fluids. The cell culture study performed herein confirmed that the correct adjustment of modification parameters results in a lack of cytotoxicity of the magnesium implants, cell proliferation enhancement, and improvement in extracellular matrix formation.

Magnetic Bone Tissue Engineering: Reviewing the Effects of Magnetic Stimulation on Bone Regeneration and Angiogenesis

Bone tissue engineering emerged as a solution to treat critical bone defects, aiding in tissue regeneration and implant integration. Mainly, this field is based on the development of scaffolds and coatings that stimulate cells to proliferate and differentiate in order to create a biologically active bone substitute. In terms of materials, several polymeric and ceramic scaffolds have been developed and their properties tailored with the objective to promote bone regeneration. These scaffolds usually provide physical support for cells to adhere, while giving chemical and physical stimuli for cell proliferation and differentiation. Among the different cells that compose the bone tissue, osteoblasts, osteoclasts, stem cells, and endothelial cells are the most relevant in bone remodeling and regeneration, being the most studied in terms of scaffold-cell interactions. Besides the intrinsic properties of bone substitutes, magnetic stimulation has been recently described as an aid in bone regeneration. External magnetic stimulation induced additional physical stimulation in cells, which in combination with different scaffolds, can lead to a faster regeneration. This can be achieved by external magnetic fields alone, or by their combination with magnetic materials such as nanoparticles, biocomposites, and coatings. Thus, this review is designed to summarize the studies on magnetic stimulation for bone regeneration. While providing information regarding the effects of magnetic fields on cells involved in bone tissue, this review discusses the advances made regarding the combination of magnetic fields with magnetic nanoparticles, magnetic scaffolds, and coatings and their subsequent influence on cells to reach optimal bone regeneration. In conclusion, several research works suggest that magnetic fields may play a role in regulating the growth of blood vessels, which are critical for tissue healing and regeneration. While more research is needed to fully understand the relationship between magnetism, bone cells, and angiogenesis, these findings promise to develop new therapies and treatments for various conditions, from bone fractures to osteoporosis.

Polycrystalline Diamond Coating on Orthopedic Implants: Realization and Role of Surface Topology and Chemistry in Adsorption of Proteins and Cell Proliferation

Polycrystalline diamond has the potential to improve the osseointegration of orthopedic implants compared to conventional materials such as titanium. However, despite the excellent biocompatibility and superior mechanical properties, the major challenge of using diamond for implants, such as those used for hip arthroplasty, is the limitation of microwave plasma chemical vapor deposition (CVD) techniques to synthesize diamond on complex-shaped objects. Here, for the first time, we demonstrate diamond growth on titanium acetabular shells using the surface wave plasma CVD method. Polycrystalline diamond coatings were synthesized at low temperatures (∼400 °C) on three types of acetabular shells with different surface structures and porosities. We achieved the growth of diamond on highly porous surfaces designed to mimic the structure of the trabecular bone and improve osseointegration. Biocompatibility was investigated on nanocrystalline diamond (NCD) and ultrananocrystalline diamond (UNCD) coatings terminated either with hydrogen or oxygen. To understand the role of diamond surface topology and chemistry in the attachment and proliferation of mammalian cells, we investigated the adsorption of extracellular matrix proteins and monitored the metabolic activity of fibroblasts, osteoblasts, and bone-marrow-derived mesenchymal stem cells (MSCs). The interaction of bovine serum albumin and type I collagen with the diamond surfaces was investigated by confocal fluorescence lifetime imaging microscopy (FLIM). We found that the proliferation of osteogenic cells was better on hydrogen-terminated UNCD than on the oxygen-terminated counterpart. These findings correlated with the behavior of collagen on diamond substrates observed by FLIM. Hydrogen-terminated UNCD provided better adhesion and proliferation of osteogenic cells, compared to titanium, while the growth of fibroblasts was poorest on hydrogen-terminated NCD and MSCs behaved similarly on all tested surfaces. These results open new opportunities for application of diamond coatings on orthopedic implants to further improve bone fixation and osseointegration.

A Simple Replica Method as the Way to Obtain a Morphologically and Mechanically Bone-like Iron-Based Biodegradable Material

Porous iron-based scaffolds were prepared by the simple replica method using polyurethane foam as a template and applying the sintering process in a tube furnace. Their surface morphology was characterized using scanning electron microscopy (SEM) and phase homogeneity was confirmed using X-ray diffraction (XRD). Corrosion behavior was determined using immersion and potentiodynamic polarization methods in phosphate buffered saline (PBS). The surface energy was calculated by studying the changes of enthalpy of calorimetric immersion. A preliminary biological test was also carried out and was done using the albumin adsorption procedure. Results of our work showed that in using the simple replica method it is possible to obtain iron biomaterial with morphology and mechanical properties almost identical to bones, and possessing adequate wettability, which gives the potential to use this material as biomaterial for scaffolds in orthopedics.

Investigating Potential Effects of Ultra-Short Laser-Textured Porous Poly-ε-Caprolactone Scaffolds on Bacterial Adhesion and Bone Cell Metabolism

Developing antimicrobial surfaces that combat implant-associated infections while promoting host cell response is a key strategy for improving current therapies for orthopaedic injuries. In this paper, we present the application of ultra-short laser irradiation for patterning the surface of a 3D biodegradable synthetic polymer in order to affect the adhesion and proliferation of bone cells and reject bacterial cells. The surfaces of 3D-printed polycaprolactone (PCL) scaffolds were processed with a femtosecond laser (λ = 800 nm; τ = 130 fs) for the production of patterns resembling microchannels or microprotrusions. MG63 osteoblastic cells, as well as S. aureus and E. coli, were cultured on fs-laser-treated samples. Their attachment, proliferation, and metabolic activity were monitored via colorimetric assays and scanning electron microscopy. The microchannels improved the wettability, stimulating the attachment, spreading, and proliferation of osteoblastic cells. The same topography induced cell-pattern orientation and promoted the expression of alkaline phosphatase in cells growing in an osteogenic medium. The microchannels exerted an inhibitory effect on S. aureus as after 48 h cells appeared shrunk and disrupted. In comparison, E. coli formed an abundant biofilm over both the laser-treated and control samples; however, the film was dense and adhesive on the control PCL but unattached over the microchannels.

Recent Advancements in Materials and Coatings for Biomedical Implants

Metallic materials such as stainless steel (SS), titanium (Ti), magnesium (Mg) alloys, and cobalt-chromium (Co-Cr) alloys are widely used as biomaterials for implant applications. Metallic implants sometimes fail in surgeries due to inadequate biocompatibility, faster degradation rate (Mg-based alloys), inflammatory response, infections, inertness (SS, Ti, and Co-Cr alloys), lower corrosion resistance, elastic modulus mismatch, excessive wear, and shielding stress. Therefore, to address this problem, it is necessary to develop a method to improve the biofunctionalization of metallic implant surfaces by changing the materials’ surface and morphology without altering the mechanical properties of metallic implants. Among various methods, surface modification on metallic surfaces by applying coatings is an effective way to improve implant material performance. In this review, we discuss the recent developments in ceramics, polymers, and metallic materials used for implant applications. Their biocompatibility is also discussed. The recent trends in coatings for biomedical implants, applications, and their future directions were also discussed in detail.

Inorganic Nanoparticles in Bone Healing Applications

Modern biomedicine aims to develop integrated solutions that use medical, biotechnological, materials science, and engineering concepts to create functional alternatives for the specific, selective, and accurate management of medical conditions. In the particular case of tissue engineering, designing a model that simulates all tissue qualities and fulfills all tissue requirements is a continuous challenge in the field of bone regeneration. The therapeutic protocols used for bone healing applications are limited by the hierarchical nature and extensive vascularization of osseous tissue, especially in large bone lesions. In this regard, nanotechnology paves the way for a new era in bone treatment, repair and regeneration, by enabling the fabrication of complex nanostructures that are similar to those found in the natural bone and which exhibit multifunctional bioactivity. This review aims to lay out the tremendous outcomes of using inorganic nanoparticles in bone healing applications, including bone repair and regeneration, and modern therapeutic strategies for bone-related pathologies.

Addressing the Needs of the Rapidly Aging Society through the Development of Multifunctional Bioactive Coatings for Orthopedic Applications

The unprecedented aging of the world's population will boost the need for orthopedic implants and expose their current limitations to a greater extent due to the medical complexity of elderly patients and longer indwelling times of the implanted materials. Biocompatible metals with multifunctional bioactive coatings promise to provide the means for the controlled and tailorable release of different medications for patient-specific treatment while prolonging the material's lifespan and thus improving the surgical outcome. The objective of this work is to provide a review of several groups of biocompatible materials that might be utilized as constituents for the development of multifunctional bioactive coatings on metal materials with a focus on antimicrobial, pain-relieving, and anticoagulant properties. Moreover, the review presents a summary of medications used in clinical settings, the disadvantages of the commercially available products, and insight into the latest development strategies. For a more successful translation of such research into clinical practice, extensive knowledge of the chemical interactions between the components and a detailed understanding of the properties and mechanisms of biological matter are required. Moreover, the cost-efficiency of the surface treatment should be considered in the development process.

Bioactive Coatings Loaded with Osteogenic Protein for Metallic Implants

Osteoconductive and osteoinductive coatings represent attractive and tunable strategies towards the enhanced biomechanics and osseointegration of metallic implants, providing accurate local modulation of bone-to-implant interface. Composite materials based on polylactide (PLA) and hydroxyapatite (HAp) are proved beneficial substrates for the modulation of bone cells' development, being suitable mechanical supports for the repair and regeneration of bone tissue. Moreover, the addition of osteogenic proteins represents the next step towards the fabrication of advanced biomaterials for hard tissue engineering applications, as their regulatory mechanisms beneficially contribute to the new bone formation. In this respect, laser-processed composites, based on PLA, Hap, and bone morphogenetic protein 4(BMP4), are herein proposed as bioactive coatings for metallic implants. The nanostructured coatings proved superior ability to promote the adhesion, viability, and proliferation of osteoprogenitor cells, without affecting their normal development and further sustaining the osteogenic differentiation of the cells. Our results are complementary to previous studies regarding the successful use of chemically BMP-modified biomaterials in orthopedic and orthodontic applications.

A Brief Insight to the Electrophoretic Deposition of PEEK-, Chitosan-, Gelatin-, and Zein-Based Composite Coatings for Biomedical Applications: Recent Developments and Challenges

Electrophoretic deposition (EPD) is a powerful technique to assemble metals, polymer, ceramics, and composite materials into 2D, 3D, and intricately shaped implants. Polymers, proteins, and peptides can be deposited via EPD at room temperature without affecting their chemical structures. Furthermore, EPD is being used to deposit multifunctional coatings (i.e., bioactive, antibacterial, and biocompatible coatings). Recently, EPD was used to architect multi-structured coatings to improve mechanical and biological properties along with the controlled release of drugs/metallic ions. The key characteristics of EPD coatings in terms of inorganic bioactivity and their angiogenic potential coupled with antibacterial properties are the key elements enabling advanced applications of EPD in orthopedic applications. In the emerging field of EPD coatings for hard tissue and soft tissue engineering, an overview of such applications will be presented. The progress in the development of EPD-based polymeric or composite coatings, including their application in orthopedic and targeted drug delivery approaches, will be discussed, with a focus on the effect of different biologically active ions/drugs released from EPD deposits. The literature under discussion involves EPD coatings consisting of chitosan (Chi), zein, polyetheretherketone (PEEK), and their composites. Moreover, in vitro and in vivo investigations of EPD coatings will be discussed in relation to the current main challenge of orthopedic implants, namely that the biomaterial must provide good bone-binding ability and mechanical compatibility.