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Recent advances in PMMA bone cement-loaded delivery systems for the treatment of open bone defect infections
Haitao Liu1, Yu Bo1, Pengcheng Gao1
1Department of Traumatic Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
Introduction:
Postoperative fracture infection can cause serious limb deformity and dysfunction. Polymethylmethacrylate (PMMA) bone cement is widely used for treating open bone defect infections, yet its limitations necessitate a review of current strategies and future directions.
Areas Covered:
This review summarizes PMMA's history, biological properties, and drug-loaded applications in orthopedics, focusing on antibiotic combination therapy for fracture defects. Literature was sourced from PubMed and Web of Science, covering studies from the clinical introduction of PMMA to recent advances published up to 2025.
Expert Opinion:
PMMA bone cement remains a critical antibiotic delivery system. While modified composites and combination strategies show promise in improving release profiles and osteogenic activity, challenges such as non-degradability, optimal pore formation, and clinical translation of bioactive additives persist. Future research should prioritize developing fully biodegradable, highly osteogenic PMMA alternatives and establishing standardized protocols for antibiotic combination therapies. The ideal solution would balance mechanical strength, drug release kinetics, and complete resorption, potentially transforming infected bone defect management within five years.
Insights
Polymethylmethacrylate (PMMA) bone cement is crucial for treating bone infections, but its limitations require new strategies. Future research focuses on biodegradable alternatives and standardized antibiotic therapies for better bone defect management.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Infectious disease management
Background:
- Postoperative fracture infections lead to severe limb deformity and dysfunction.
- Polymethylmethacrylate (PMMA) bone cement is a common treatment for open bone defect infections.
- Limitations of current PMMA necessitate a review of strategies and future directions.
Purpose of the Study:
- To review the history, biological properties, and drug-loaded applications of PMMA in orthopedics.
- To focus on antibiotic combination therapy for fracture defects.
- To identify current challenges and future research directions for PMMA in bone defect management.
Main Methods:
- Comprehensive literature search of PubMed and Web of Science databases.
- Inclusion of studies from PMMA's clinical introduction to recent advances up to 2025.
- Review focused on antibiotic-loaded PMMA for orthopedic fracture defects.
Main Results:
- PMMA bone cement is a critical antibiotic delivery system in orthopedics.
- Modified composites and combination strategies show potential for improved drug release and osteogenic activity.
- Challenges include PMMA's non-degradability, pore formation, and clinical translation of bioactive additives.
Conclusions:
- Further research is needed to develop biodegradable, osteogenic PMMA alternatives.
- Standardized protocols for antibiotic combination therapies are essential.
- The ideal solution requires balancing mechanical strength, drug release, and resorption for infected bone defect management.
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