Rapid Photo-Sonotherapy for Clinical Treatment of Bacterial Infected Bone Implants by Creating Oxygen Deficiency Using Sulfur Doping

Periprosthetic infection is considered the main cause of implant failure, which is expected to be solved by fabricating an antibacterial coating on the surface of the implant. Nevertheless, systemic antibiotic treatment still represents the mainstream method for preventing infection, and few antibacterial coatings are applied clinically. This is because the externally introduced traditional antibacterial coatings suffer from the risk of invalidation and tissue toxicity induced by the consumption of antibacterial agents, degradation, and shedding. In this work, we proposed a rapid photo-sonotherapy by creating an oxygen deficiency on a titanium (Ti) implant through sulfur (S)-doping (Ti-S-TiO_2-x), which endowed the implants with great sonodynamic and photothermal ability. Without introducing an external antibacterial coating, it reached a high antibacterial efficiency of 99.995% against Staphylococcus aureus under 15 min near-infrared light and ultrasound treatments. Furthermore, bone infection was successfully treated after combination treatments, and improved osseointegration was observed. Importantly, the S-doped Ti implant immersed in water for 6 months showed an unchanged structure and properties, suggesting that the Ti implant with intrinsic modification showed stable antibacterial performance under exogenous stimuli with a high antibacterial performance in vivo. This photo-sonotherapy based on sulfur doping is also promising for cancer therapy with biosafety.