Antibiotic eluting bone void fillers: A review of current applications and future directions

Antibiotic-eluting bone void fillers have emerged as an important adjunct in the management of orthopaedic infections, combining defect reconstruction with high local antibiotic delivery. Although these materials are increasingly utilized in trauma, oncologic reconstruction, and chronic osteomyelitis, the literature lacks a comprehensive clinical review focused specifically on antibiotic-eluting systems. Therefore, the purpose of this study was to evaluate the material characteristics and clinical applications of antibiotic-eluting bone void fillers used in orthopaedic practice. A review of the current literature highlighting the uses of antibiotic-eluting bone void fillers in orthopaedic trauma, oncology, and infection management was performed utilizing peer-reviewed sources from PubMed, SCOPUS, and Google Scholar. Polymethylmethacrylate (PMMA) remains the historical standard for local antibiotic delivery but is limited by non-resorbability and incomplete antibiotic elution. Resorbable calcium-based carriers, particularly calcium sulfate and biphasic calcium sulfate-hydroxyapatite composites, demonstrate high infection eradication rates in chronic osteomyelitis and fracture-related infection while eliminating the need for secondary removal procedures. Calcium phosphate ceramics provide sustained structural support with variable antibiotic release kinetics. Bioactive glass exhibits intrinsic antimicrobial activity without antibiotic incorporation and has shown favorable outcomes in selected infection settings. Across reviewed studies, calcium sulfate carriers demonstrated infection eradication rates approaching 92%, while biphasic calcium sulfate-hydroxyapatite composites achieved eradication rates up to 96% in chronic osteomyelitis series. Similarly, S53P4 bioactive glass demonstrated infection control rates of approximately 90-92.6% despite not requiring direct antibiotic incorporation. Local antibiotic carriers consistently achieve high local drug concentrations with minimal systemic toxicity, though complication profiles vary by material composition and resorption behavior. Antibiotic-eluting bone void fillers have expanded antimicrobial and reconstructive capabilities in orthopaedic trauma, oncology, and infection management. While no single material is universally superior, optimal outcomes require integration of these materials with meticulous debridement, stable fixation, and appropriate systemic therapy. Continued comparative clinical studies are needed to refine material selection and generate standardized treatment algorithms.