Recent Advances in Antibacterial Coatings to Combat Orthopedic Implant-Associated Infections Orthopedic implant-associated infections (IAIs) are a major health burden due to the complex structure of biofilms and their resistance to antimicrobial agents and the immune system. Surgical removal and long-term antibiotic treatment are the main options for eradicating biofilms on implants. Recent research has focused on developing robust strategies to prevent and treat IAIs, particularly through the use of materials with anti-biofouling and antibacterial properties. This review highlights recent advances in the development of modified implant surfaces and antibacterial coatings to inhibit bacterial attachment and biofilm formation on orthopedic implants. It also discusses the use of safe, biocompatible materials for local delivery of combinatorial antimicrobial agents to prevent and treat IAIs and overcome antimicrobial resistance. Biofilm formation on orthopedic implants is a significant challenge, as biofilms are complex matrices that provide bacteria with resistance to antibiotics and the immune system. Strategies to prevent biofilm formation include surface modification, anti-biofouling surfaces, and contact-killing surfaces. Anti-biofouling surfaces, such as superhydrophobic and superhydrophilic surfaces, reduce bacterial adhesion. Contact-killing surfaces use nanostructures to physically damage bacteria. Antibacterial coatings, including those based on biopolymers and nanoparticles, are also effective in preventing biofilm formation and reducing bacterial adhesion. Recent advances in coating technologies include the use of hydrogels, polymeric coatings, and self-assembled nanostructures for sustained drug release. These coatings can deliver antibacterial agents locally, reducing systemic side effects and improving treatment outcomes. The development of safe, durable, and effective coatings is crucial for preventing IAIs and improving the success of orthopedic implants. Future research should focus on the integration of interdisciplinary approaches to design multifunctional coatings and personalized implants that enhance biocompatibility and reduce infection risks.Recent Advances in Antibacterial Coatings to Combat Orthopedic Implant-Associated Infections Orthopedic implant-associated infections (IAIs) are a major health burden due to the complex structure of biofilms and their resistance to antimicrobial agents and the immune system. Surgical removal and long-term antibiotic treatment are the main options for eradicating biofilms on implants. Recent research has focused on developing robust strategies to prevent and treat IAIs, particularly through the use of materials with anti-biofouling and antibacterial properties. This review highlights recent advances in the development of modified implant surfaces and antibacterial coatings to inhibit bacterial attachment and biofilm formation on orthopedic implants. It also discusses the use of safe, biocompatible materials for local delivery of combinatorial antimicrobial agents to prevent and treat IAIs and overcome antimicrobial resistance. Biofilm formation on orthopedic implants is a significant challenge, as biofilms are complex matrices that provide bacteria with resistance to antibiotics and the immune system. Strategies to prevent biofilm formation include surface modification, anti-biofouling surfaces, and contact-killing surfaces. Anti-biofouling surfaces, such as superhydrophobic and superhydrophilic surfaces, reduce bacterial adhesion. Contact-killing surfaces use nanostructures to physically damage bacteria. Antibacterial coatings, including those based on biopolymers and nanoparticles, are also effective in preventing biofilm formation and reducing bacterial adhesion. Recent advances in coating technologies include the use of hydrogels, polymeric coatings, and self-assembled nanostructures for sustained drug release. These coatings can deliver antibacterial agents locally, reducing systemic side effects and improving treatment outcomes. The development of safe, durable, and effective coatings is crucial for preventing IAIs and improving the success of orthopedic implants. Future research should focus on the integration of interdisciplinary approaches to design multifunctional coatings and personalized implants that enhance biocompatibility and reduce infection risks.