Bioelectric warfare on bone infection: The role of piezoelectric biomaterials in osteomyelitis management

• Piezoelectric biomaterials utilize ultrasound-generated electrical signals to combat bone infection. • They eradicate biofilms via ROS-dependent and independent mechanisms, avoiding resistance. • Electrical stimulation mimics natural bone bioelectricity, enhancing regeneration. • Advanced composites enable synergistic anti-infection and bone-repair therapy. • This platform technology pioneers a new strategy for managing complex osteomyelitis. Piezoelectric materials represent an emerging frontier in osteomyelitis therapy, offering innovative solutions to persistent challenges in bone infection treatment. These materials utilize their inherent electromechanical coupling properties to convert external stimuli, such as ultrasound and mechanical stress, into localized electrical signals. This capability facilitates targeted antibacterial effects through enhanced reactive oxygen species (ROS) generation, promotes endogenous growth factor secretion, and stimulates osteogenic differentiation—all while supporting bone regeneration. Recent advances in nano-piezoelectric systems, including hybrid organic-inorganic composites, demonstrate significant potential for addressing the complex pathophysiology of osteomyelitis, including biofilm formation, avascular necrosis, and impaired osseointegration. This review examines material classifications, antibacterial mechanisms, and regenerative applications of piezoelectric technology in bone infection management, highlighting their role in combined antibacterial-osteogenic strategies. With compelling preclinical outcomes, these materials pave the way for next-generation therapies that simultaneously eradicate infection and promote bone repair. Future research should prioritize optimizing biodegradability, enhancing piezoelectric efficiency in biological environments, and integrating these materials with conventional debridement and antibiotic therapies for clinical translation.