Abstract: With the increasing application of orthopedic implants, implant-associated infections have become a critical challenge in clinical practice. To mitigate infection risks, local antimicrobial strategies have emerged, which involve loading implants with substances such as antibiotics, silver, iodine, and quaternary ammonium compounds to achieve localized antibacterial effects. Existing research indicates that certain coatings have demonstrated potential in reducing infections in clinical trials, showing particular promise in high-risk patients, such as those with bone tumors. However, the safety profiles of different coatings vary. Silver coatings may lead to localized reactions like argyria, while antibiotic coatings carry potential risks of drug resistance. This paper reviews the technological advancements, current clinical applications, and safety concerns of antimicrobial-coated orthopedic implants, aiming to provide insights for promoting standardized and optimized use of this technology in preventing and controlling orthopedic infections.