Although titanium (Ti) implants are widely used clinically, implant-associated bacterial infection is still one of the most serious complications in orthopedic surgery. Long-term antibacterial properties and the ability to inhibit biofilm formation are highly desirable to prevent implant associated infection. In this study, a controllable amount of silver (Ag) nanoparticles was incorporated into titanium oxide; or titanium, nanotubes (TiO2-NTs). The reliable release and long-term antibacterial function of Ag, in vivo and in vitro, and influence normal bone-implant integration from the Ag released from Ag-incorporated NTs in vivo have been studied to make them useable in clinical practice. In the current study, TiO2-NTs loaded with Ag (NT-Ag) exhibited strong antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA, ATCC43300) in vitro for 30 days, and the ability to penetrate the protein layer well. In addition, Xray examination and 2-[F-18]-fiuoro-2-deoxy-D-glucose positron emission tomography indicates that NT-Ag show extremely long antibacterial activity in vivo in a rat model. Furthermore, histomorphometric analysis demonstrated that satisfactory bio-integration can be expected. Our results indicate that NT-Ag has both simultaneous antimicrobial and excellent bio-integration properties, make it a promising therapeutic material for orthopedic application. (C) 2013 Wiley Periodicals, Inc.