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A Novel Method to Determine the Longitudinal Antibacterial Activity of Drug-Eluting Materials
Published on: March 3, 2023
Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement
William A Jiranek1, Arlen D Hanssen, A Seth Greenwald
1Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, P.O. Box 980153, Richmond, VA 23298-0153, USA.
The Journal of Bone and Joint Surgery. American Volume
|November 3, 2006
Summary
Antibiotic-loaded bone cement is not recommended for routine joint replacement prophylaxis. Commercially available products are superior for specific two-stage revision surgeries after infection elimination, not active infection treatment.
Area of Science:
- Orthopedic surgery
- Infectious disease prevention
- Biomaterials science
Background:
- Antibiotic-loaded bone cement (ALBC) is utilized in joint replacement surgery.
- Concerns exist regarding the optimal use and efficacy of ALBC for infection prophylaxis and treatment.
- Variability in properties between hand-mixed and commercially prepared ALBC.
Purpose of the Study:
- To clarify the indications for using ALBC in joint replacement surgery.
- To compare the properties of commercially available versus hand-mixed ALBC.
- To define the role of ALBC in prophylaxis versus active infection treatment.
Main Methods:
- Review of current clinical guidelines and FDA clearance for ALBC products.
- Analysis of mechanical and elution properties of premixed and hand-mixed ALBC.
- Comparison of antibiotic dosing in prophylactic versus therapeutic applications.
Main Results:
- ALBC is not indicated for routine prophylaxis in low-risk patients undergoing primary or revision joint replacement.
- Commercially available premixed ALBC demonstrates superior mechanical and elution properties compared to hand-mixed preparations.
- FDA clearance for commercial ALBC is limited to the second stage of two-stage total joint revision after infection elimination.
Conclusions:
- ALBC is not a substitute for appropriate antibiotic therapy in active periprosthetic joint infections.
- The use of ALBC should be restricted to specific indications, primarily in revision arthroplasty following infection eradication.
- Commercially prepared ALBC offers advantages in consistency and performance for its approved indications.
