A Review of Magnesium Alloys In Vivo Antibacterial Properties: Challenges, Solutions, and Perspectives in Implant-Associated Orthopedic Infections

Magnesium (Mg) and its alloys are promising materials for medical applications due to their biodegradability and biocompatibility. While Mg has inherent antibacterial properties, further enhancements are essential to meet clinical needs. A major challenge is achieving effective antimicrobial performance alongside controlled corrosion rates. This review examines in vivo studies and preclinical trials of antimicrobial Mg alloys and coatings, exploring their antibacterial mechanisms, the impact of additives, and the role of coatings in enhancing performance. It highlights the dual role of antimicrobial additives, which improve antibacterial action but may accelerate corrosion, complicating clinical use. Advances in coating technologies are discussed, focusing on strategies to incorporate antimicrobial elements while reducing corrosion and improving biocompatibility. Insights from recent in vivo studies and preclinical trials shed light on real-world effectiveness, safety, and regulatory challenges. The review emphasizes the progress made in developing antimicrobial Mg alloys and identifies critical challenges for their clinical applications. Continued research is needed to optimize these materials for safe and effective use, contributing to improved patient outcomes and advancing biomaterials science.