Authors: Philip C Noble, Olga Pidgaiska, Carla Renata Arciola, Zack Coffman, Sara Stephens, Sabir Ismaily, Ryan Blackwell, Davide Campoccia, Lucio Montanaro

RESPONSE: The attachment of bacteria to implant and biological surfaces is a complex process, starting with the initial conditioning film. Roughness, hydrophobicity/hydrophilicity, porosity, pore topology and other surface conditions are the key factors for microbial adhesion. Because of the huge variety of these factors, most of the studies directed at bacterial attachment to the implant surface were limited to specific surface conditions since it is difficult to examine the plethora of parameters concomitantly. There are variable conclusions among the available basic science and animal studies relevant to this topic, many of which will be described in greater detail below. Bacteria can form biofilm on almost all prosthetic surfaces and biological surfaces. To date, this consensus group knows of no surface that is inimicable to the growth of biofilm in vivo.

LEVEL OF EVIDENCE: Strong

DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus)

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