Nanomaterials for Anti-Infection in Orthopedic Implants: A Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors present an overview of the literature on nanomaterials in post-orthopedic surgery infections, categorising their bactericidal mechanisms.

The title accurately represents the topic and the argument is well-analysed.

The publication of this review raises no major concerns. However, it is suggested that a list of the main abbreviations used in Table 1 be added.

Comments on the Quality of English Language

I recommend checking the English language and punctuation.

Author Response

Thank you for your review and many valuable recommendations for further improvements. Our research team discussed and learned from your valuable suggestions. We appreciate all the comments, which have been a great help for improving the quality of our future research.

We have listed the main abbreviations used in Table 1 below the table and refined it. Among them, some abbreviations have been explained in the body and will not be listed.

We have made improvements to the English language and punctuation.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors extensively describe the state of the art of nanomaterilals for anti infection orthopedic implants, underlying advantages, such as therapeutical approcahes, and limits, such as the lack of commercially avaiable products that are cost -effective. 

Author Response

Thank you for your careful review.

Reviewer 3 Report

Comments and Suggestions for Authors

The authors present a list of different nanomaterials used in orthopedic implants aiming to prevent infection. The presentation is well organized. However, the authors should enlarge their review by adding some of their in-depth knowledge on the subject, such as: the best suited nanomaterials for different types of implants, bulk or porous, also considering their composition. 

As the orthopedic implants include a large variety of designs aiming to better serve their functional purposes, this is a must of such review. The simple presentation of a list of results taken from other authors is not sufficient for a quality review. 

Also, please add (line 225) not only the weight of the Ag nanoparticles, because it has no meaning if their concentration on the scaffold is not known. So, instead of "27.71 μg" it should be presented as "27.71 μg/ weight of the scaffold". This value is not given in the cited paper but can be estimated by considering the presented experimental data. 

Author Response

Thank you for your review and many valuable recommendations for further improvements. Our research team discussed and learned from your valuable suggestions. We appreciate all the comments, which have been a great help for improving the quality of our future research. We have checked the manuscript and revised it according to the comments. The detailed point-by-point corrections are listed below.

1. Thank you for your comments. It must be explained that the orthopedic implants targeted in this review mainly include titanium alloy based orthopedic components, such as bone screws, bone nails, bone plates and fixators. Because the current clinical orthopedic implants are still mainly metal orthopedic components. Its functional purpose is also relatively simple, aiming to fix fractures after reduction and replace unusable joints. Regardless of the type of implant, their antibacterial effect currently depends on the surface modification of the implant. Therefore, the focus of this paper is on the discussion of nanomaterials, rather than on what type of implant. Other types of implants, such as artificial bones, are less commonly used and are not covered by this review.

2. Thank you for your careful review. We apologize for this negligence. In light of your question, we have consulted the citation. This data is mentioned twice in the original text, respectively: "The total loading of Ag was determined to be 27.71±2.56 µg per scaffold" and "Consequently, silver was immobilized as high as 27.71 µg per scaffold". This value is really fuzzy and controversial, and it does not affect the viewpoint that micro/nanoscale pores increased the total surface area of the scaffolds. So we decided to remove this value from the review.

Reviewer 4 Report

Comments and Suggestions for Authors Line 47: Please mention specifically what type of loss is it? Line 51: Before going into the advantages of nanomaterials, a chapter specifically discussing the failure or disadvantages of previous technique using microsizes/larger sizes can be mentioned. This can show your strong motivation to write this paper.   Perhaps this table (Table 1) can be alocated at the end of the article before the summary.   Line 94: It is good to include other abbreviations in Table 1 caption.   Line 171: Perhaps to revise  whether PK should be in the inorganic section or not? Perhaps it should be in the organic NP.section instead.   Line 532: Rather than straight dividing into further sections, the reviewer would suggest that the whole discussion on the specific shapes can be grouped into one section.    Later, the authors can divide these into nanopillars subsection and so on. It is advisable that an introduction can be

added to the reason why it is so important to discuss nanoshapes. Definitely, there are other criteria which are also important, but why the authors are going into this direction.

Please refer to the manuscript. The reviewers comments are there.

Comments for author File: Comments.pdf

Author Response

Thank you for your review and many valuable recommendations for further improvements. Our research team discussed and learned from your valuable suggestions. We appreciate all the comments, which have been a great help for improving the quality of our future research. We have checked the manuscript and revised it according to the comments. The detailed point-by-point corrections are listed below.

1. Line 47: Thank you for your suggestion. We apologize for any inconvenience caused by this error. We have specified further in the original article what the loss is.

2. Line 51: Thank you for your reasonable advice. We have added a description of the disadvantages of previous technique using microsizes sizes before going into the advantages of nanomaterials. Meanwhile, Table 1 has been alocated at the end of the article before the summary.

3. Line 94: Other abbreviations in Table 1 are already mentioned in the main text. So they are not explained again in the table.

4. Line 171 (I'm sorry, this is actually line 471): Thank you for your suggestion. We apologize for any inconvenience caused by this error. We have reclassified it according to what you said.

5. Line 532: Thank you for your sound advice. We've combined the whole discussion on the specific shapes into one section. At the same time, the importance of nanometer morphology is introduced. The construction of nanomorphic features can exert antibacterial effects by inhibiting bacterial adhesion from the outset, while also having a range of advantages. Therefore, we believe that nano-morphology is particularly important among many criteria.

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Accept