Antibiotic-loaded bone cement and periprosthetic joint infection

Antibiotic-loaded bone cement (ALBC) is commonly used for antibiotic delivery during total joint arthroplasty (TJA) for prevention or treatment of periprosthetic joint infection (PJI). ALBC is commonly used in two-stage exchange arthroplasty with static and dynamic spacers, beads, rods, and other custom spacers. The use of commercially available or hand-made ALBC for primary and revision TJA to prevent infection has also been studied. Commonly used antibiotics include gentamicin, tobramycin, and vancomycin powder, and these antibiotics can be used alone or in combination, depending on the organism present. ALBC can be prepared by hand mixing to increase porosity and improve antibiotic elution or by vacuum-mixing to improve tensile fatigue strength. Vacuum-mixed cement is predominantly used in primary TJA, whereas hand-mixed cement is often used in two-stage exchange arthroplasty for shaping spacers and beads. Inadequate strength of ALBC spacers can result in mechanical failure, including fracture or dislocation of spacers. Additionally, studies have demonstrated that the use of antibiotics in cement, especially aminoglycosides like gentamicin and tobramycin that can elute into the bloodstream, may result in acute renal failure. Using antibiotics in ALBC can also theoretically increase antibiotic resistance and the likelihood of obtaining a negative culture if subsequent aspirations are performed. Overall, ALBC is an effective medical implant tool that can be used for treating and preventing PJI.