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Antibiotic cements in articular prostheses: current orthopaedic concepts
F Langlais1, N Belot, M Ropars
1Federation of Orthopaedic Surgery, University Hospital Sud, 35203 Rennes, France; Bone Biomaterials Laboratory, University of Rennes 1, Rennes, France. frantz.langlais@chu-rennes.fr
International Journal of Antimicrobial Agents
|June 27, 2006
Summary
Antibiotic cements (ACs) are effective in preventing and treating prosthetic joint infections, showing significant infection rate reduction and improved outcomes in total hip replacements. ACs demonstrate safety and efficacy as an adjuvant therapy.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomaterials Science
Background:
- Antibiotic cements (ACs) are approved for prophylaxis and treatment of orthopedic infections.
- Extensive research has evaluated their efficacy and safety in laboratory and clinical settings.
Purpose of the Study:
- To assess the possibilities and limits of antibiotic cements (ACs).
- To evaluate the efficacy of ACs in preventing and treating prosthetic joint infections.
Main Methods:
- Laboratory experiments assessing antibiotic delivery and mechanical properties.
- Animal studies (sheep) evaluating bone cortex antibiotic concentrations.
- Human pharmacokinetic studies during total hip replacement (THR).
- Analysis of prospective studies and arthroplasty register data.
Main Results:
- Satisfactory antibiotic delivery without compromising mechanical properties in lab studies.
- Sustained high antibiotic concentrations in bone and drainage fluids in animal and human studies.
- Significant reduction in infection rates (approx. 50%) in THR prophylaxis.
- Improved infection control rates in infected prostheses, especially with one-stage exchange using ACs.
- No observed toxic effects, allergies, mechanical failures, or resistant microorganism selection.
Conclusions:
- Antibiotic cements are a safe and effective adjuvant treatment for orthopedic infections.
- ACs significantly reduce infection rates in total hip replacement prophylaxis and treatment.
- One-stage exchange with ACs offers better functional outcomes, lower cost, and reduced patient morbidity compared to two-stage exchange without local antibiotics.
