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This review reframes antibacterial and immunomodulatory coatings as regulators of a dynamic implant biointerface rather than as isolated bactericidal or drug\u2010eluting layers. We first outline the biological coupling among protein conditioning, bacterial adhesion, biofilm maturation, macrophage\u2010mediated inflammation, corrosion, surface topography, and bone integration. We then summarize design requirements for orthopedic metal implant coatings, including cytocompatibility, anti\u2010biofilm efficacy, immune balance, osteogenic support, mechanical adhesion, wear durability, and electrochemical stability. Antibacterial strategies are discussed according to ion\u2010releasing and metal oxide coatings, bioceramic and bioactive glass\u2010based systems, antimicrobial cargo delivery, contact\u2010killing and anti\u2010adhesive surfaces, and externally activated responsive coatings. Immunomodulatory strategies are organized around local anti\u2010inflammatory delivery, natural molecules, cytokine or growth factor presentation, ion\u2010mediated osteoimmunomodulation, and redox or thermal regulation. Finally, we highlight multifunctional coating architectures, fabrication\u2010dependent structure\u2013function relationships, integrated validation frameworks, and translational barriers. This Review provides a design\u2010oriented framework for developing clinically translatable orthopedic implant interfaces that coordinate infection control, immune regulation, osseointegration, and long\u2010term stability.<\/jats:p>","DOI":"10.1002\/adhm.202600008","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T03:47:06Z","timestamp":1783309626000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Antibacterial and Immunomodulatory Coatings for Orthopedic Metal Implants: Biological Rationale, Design Strategies, and Translational Challenges"],"prefix":"10.1002","volume":"15","author":[{"given":"Zhi","family":"Mao","sequence":"first","affiliation":[{"name":"Provincial Key Laboratory of Tooth Development and Bone Remodeling Hospital of Stomatology Jilin University  Changchun China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanyao","family":"Dong","sequence":"additional","affiliation":[{"name":"Provincial Key Laboratory of Tooth Development and Bone Remodeling Hospital of Stomatology Jilin University  Changchun China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yifan","family":"Jia","sequence":"additional","affiliation":[{"name":"Provincial Key Laboratory of Tooth Development and Bone Remodeling Hospital of Stomatology Jilin University  Changchun China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopedics Beijing Luhe Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2226-1514","authenticated-orcid":false,"given":"Wei","family":"Zhijian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics Qilu Hospital of Shandong University  Jinan P. 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