Adherent lipopolysaccharide inhibits the osseointegration of orthopedic implants by impairing osteoblast differentiation

► Debris containing LPS from Gram-negative bacteria exists on clinical implants. ► Levels of bacterial debris vary between different lots of implants and within an individual lot. ► Ultrapure LPS adherent to implants inhibited osseointegration through TLR-4. ► Ultrapure LPS adherent to titanium alloy discs inhibited MC3T3-E1 differentiation and mineralization in vitro. ► LPS may inhibit osseointegration in part through cell autonomous effects on osteoblasts.