Remote eradication of delayed infection on orthopedic implants via magnesium-based total morphosynthesis of biomimetic mineralization strategy

[Display omitted] Orthopedic late infection represents one of the major threats for bone implants failure during their life cycles. Herein, we demonstrate that a late-term antimicrobial strategy incorporating a sophisticated multilayered coating system leveraging multiple ion exchange mechanisms and fine total morphosynthesis tuning, could effectively promote osteointegration at the early stage and eradicate delayed bacterial infection at late stage of implantation. In the early stage, sustained release of Ca2+ and PO43-during CaP coating degradation substantially promoted implant osseointegration by showing more peri-implant new bone formation and substantially improved bone-implant bonding strength. In the late stage, the underlying magnesium titanate fiber network enables a long-term contact and release killing effect of residual magnesium, which maintained a strong antibacterial ability against both Staphylococcus aureus and Escherichia coli even after the removal of top layer coating. Moreover, underlying magnesium titanate layer ensure possibility to mediating the growth of the total morphosynthesis of calcium phosphate coating on the substrates, which could apply to versatile medical implants fields. •The coating system with total morphosynthesis combating delayed bacterial infection by novel tardive strategy.•Synthetic lamellar coatings exhibit excellent osteointegration effects in infectious scenarios.•Multifunctional coating system via ion exchange and biomineralization techniques.•A series of animal models replicating clinical scenario such as osteomyelitis, implant revision. Orthopedic delayed and late infections are devastating afflictions for patients who have undergone implantation. Even though versatile antibacterial modification on medical devices brought the hope of eradicating pathogenic bacteria. The synthesis of late-term antibacterial properties with total morphosynthesis on medical devices nonetheless remains an elusive goal. Herein, we utilize a mineralized strategy coupled with ion exchange to generate lamellar-type magnesium calcium phosphate thin films with a three-step pathway: Construction of nanofiber porous structure on the substrate as ions reservoir, incorporation of magnesium substitutional transition sodium titanate layer, and mineralization of a lamellar calcium phosphate coating. Synthetic lamellar coatings exhibit excellent osteointegration effects in infectious scenarios. More importantly, the underlying transition la