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The use of antimicrobial-impregnated PMMA to manage periprosthetic infections: controversial issues and the latest

H L Tan1, W T Lin, T T Tang

  • 1Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

The International Journal of Artificial Organs
|November 10, 2012
PubMed

Insights

Antibiotic-loaded polymethylmethacrylate (PMMA) bone cement is used for joint replacement infections, but outcomes vary. Chitosan-based PMMA shows promise for improved bone integration and antibacterial activity against resistant strains.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Infectious Diseases

Background:

  • Periprosthetic joint infection remains a significant challenge in arthroplasty despite surgical and implant advancements.
  • Systemic antibiotics are often ineffective for deep-seated infections due to poor drug penetration.
  • Antibiotic-impregnated polymethylmethacrylate (PMMA) bone cement is a common local drug delivery system, but its efficacy is debated.

Purpose of the Study:

  • To evaluate the effectiveness of novel antibacterial agents in PMMA for treating periprosthetic joint infections.
  • To identify agents that combat antibiotic-resistant bacteria and promote osteointegration.
  • To explore chitosan and its derivatives as potential PMMA additives.

Main Methods:

  • Review of current literature on antibiotic-loaded PMMA for arthroplasty infections.
  • Analysis of preclinical studies investigating new antimicrobial agents for bone cement.
  • Focus on agents with dual antibacterial and osteogenic properties.

Main Results:

  • The effectiveness of traditional antibiotic-loaded PMMA is inconsistent and can lead to antibiotic resistance.
  • Local antibiotic use may negatively impact osteogenic cell function.
  • Preclinical studies indicate chitosan-loaded PMMA exhibits both antibacterial and osteogenic potential.

Conclusions:

  • There is a need for improved local antimicrobial strategies in arthroplasty to overcome resistance and enhance bone healing.
  • Chitosan and its derivatives represent a promising alternative for developing next-generation PMMA bone cements.
  • Further research is warranted to validate the clinical efficacy of chitosan-modified PMMA in preventing and treating periprosthetic joint infections.

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