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To address this, antimicrobial peptides (HHC36)\u2010loaded titania nanotubes (NTs) are\u00a0developed on titanium screws (Ti\u2010NTs\u2010P\u2010A), which integrate pH\u2010responsive polymethacrylic acid to control HHC36 release for eradicating bacteria in IASO. Colony\u2010forming unit assay confirmed that Ti\u2010NTs\u2010P\u2010A screws maintained sustainable antibacterial effectiveness, killing over 65% of <jats:italic>S. aureus<\/jats:italic> even after multiple bacterial solution replacements. Notably, Ti\u2010NTs\u2010P\u2010A screws exhibit significant pH\u2010responsive HHC36 release behavior and bactericidal activity, consistent with the phenotype of peptides\u2010killed bacteria from scanning electron microscopy. Transcriptome sequencing results reveal that Ti\u2010NTs\u2010P\u2010A screws interfered with ribosome formation and disrupted the arginine biosynthesis, which is crucial for bacterial survival in acidic environments. In the non\u2010infected implant model, the bone\u2010implant contact ratio of the Ti\u2010NTs\u2010P\u2010A screw is 2.3 times that of the clinically used titanium screw. In an IASO model, Ti\u2010NTs\u2010P\u2010A screws effectively eradicated bacteria within the OLCN, achieving an 80% infection control rate and desirable osteointegration. Collectively, Ti\u2010NTs\u2010P\u2010A screws with pH\u2010responsive antibacterial properties exhibit great potential for eradicating bacteria and achieving osseointegration in IASO.<\/jats:p>","DOI":"10.1002\/adhm.202403261","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T02:09:25Z","timestamp":1732759765000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Efficacy of pH\u2010Responsive Surface Functionalized Titanium Screws in Treating Implant\u2010associated <i>S. aureus<\/i> Osteomyelitis with Biofilms Formation"],"prefix":"10.1002","volume":"14","author":[{"given":"Hang","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Orthopaedics The Second Affiliated Hospital of Chongqing Medical University  Chongqing 400010 P. R. 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