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ORIGINAL RESEARCH

Surface-modified and antibiotic-loaded polylactic acid implants: Experimental and clinical evaluation

Leticia Ramos Dantas1 ,  Gabriel Burato Ortis1 ,  Paula Hansen Suss1 ,  Ricardo Brito2 ,  Livia Munhoz da Rocha Buschle1 ,  Celso Junior Aguiar Mendonça3 ,  Matheus Fernandes Antunes1 ,  Gabriel Olesczuk1 ,  Gustavo Henrique Loesch4 ,  Maíra de Mayo Oliveira Nogueira Loesch4 ,  Thais Andrade Costa Casagrande5 ,  Marcelo de Paula Loureiro5 ,  Raoni Pablo Ricardo Gonçalves6 ,  Paulo Soares6 ,  Felipe Francisco Tuon1*
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1 Laboratory of Emerging Infectious Diseases, Department of Internal Medicine, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
2 Department of Neurosurgery, Cajuru University Hospital, Curitiba, Paraná, Brazil
3 Department of Orthopedics, Clinic Hospital Complex, Federal University of Paraná, Curitiba, Paraná, Brazil
4 Florida Christian University, Orlando, Florida, United States of America
5 Department of Biotechnology, School of Medicine, Universidade Positivo, Curitiba, Paraná, Brazil
6 Department of Mechanical Engineering, Polytechnic School, Pontificia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
BMT, 137 https://doi.org/10.12336/bmt.25.00137
Submitted: 6 August 2025 | Revised: 29 May 2026 | Accepted: 3 July 2026 | Published: 17 August 2026
© 2026 by the Author(s). Licensee Biomaterials Translational, USA. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 (CC BY-NC-SA 4.0) (https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en)
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Abstract

Polylactic acid (PLA) is a biodegradable polymer with increasing applications in surgery due to its biocompatibility and customizability. Incorporating antibiotics into PLA implants may enhance their antimicrobial effectiveness and reduce post-operative complications. In this study, PLA implants were fabricated using three-dimensional printing and impregnated with vancomycin, imipenem, polymyxin, or aztreonam. Surface morphology, antibacterial activity, in vivo biocompatibility, and efficacy were assessed. Finally, a pilot clinical study evaluated safety and preliminary outcomes in patients undergoing cranioplasty with personalized antibiotic-loaded PLA implants. Scanning electron microscopy revealed microstructured surfaces with pores between 1 μm and 5 μm in the PLA-treated group, which were absent in the control group. Antibiotic-loaded PLA discs exhibited clear inhibition zones in vitro, with reduced bacterial load and biofilm formation. Histological analysis showed decreased inflammatory infiltrates and improved collagen organization in antibiotic-treated groups, especially with vancomycin and imipenem. In the pilot clinical phase (n = 10), antibiotic–PLA implants showed high biocompatibility, minimal complications, and good anatomical fit. Only one implant-related infection occurred, caused by an antibiotic-resistant pathogen. Surface modification and antibiotic impregnation of PLA implants enhanced antimicrobial activity while maintaining biocompatibility. This approach shows promise for cranioplasty and other surgical applications, with favorable preliminary clinical outcomes supporting its safety and translational potential.

Keywords
Cranioplasty
Vancomycin
Polylactic acid
Reverse engineering
Funding
This study was funded by the Brazilian National Council for Scientific and Technological Development (CNPq/MCTI No 10/2023).
Conflict of interest
The authors declare that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
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