Antibiotic-loaded bone cement in total joint arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Biomaterials Science

Background:

• Periprosthetic joint infection (PJI) is a severe complication following total joint replacement (TJR).
• Systemic antibiotic prophylaxis is standard for PJI prevention.
• The role of local antibiotics delivered via bone cement remains debated.

Purpose of the Study:

• To evaluate the pros and cons of routine local antibiotic use in bone cement for primary and revision total joint arthroplasty.
• To explore antibiotic-loaded cement spacers in two-stage revision for infected joints.
• To discuss alternative antibiotics and optimal dosing strategies.

Main Methods:

• Literature review and critical analysis of existing studies on antibiotic prophylaxis in TJR.
• Discussion of clinical evidence regarding the efficacy and risks of local antibiotic delivery.
• Exploration of current practices and future directions in PJI prevention and treatment.

Main Results:

• Systemic antibiotic prophylaxis is a cornerstone in preventing PJI.
• The routine use of local antibiotics in bone cement for primary TJR is controversial.
• Antibiotic-loaded cement spacers are accepted in two-stage revision for infected joints.

Conclusions:

• The routine use of local antibiotics in bone cement requires careful consideration of benefits versus risks.
• Further research is needed on optimal antibiotic choices, dosages, and delivery systems.
• Effective prevention and management strategies are essential for improving outcomes in total joint arthroplasty.