Antibiotic-loaded cement in total joint arthroplasty: a comprehensive review

This review evaluates the decision-making framework for using antibiotic-loaded cement (ALC) in the management of prosthetic joint infection (PJI). Drawing on available literature, we offer orthopaedic surgeons a guided discussion on several critical considerations. First, we explore the impact of a...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 2024-12, Vol.144 (12), p.5165-5175
Main Authors: Fraval, Andrew, Zhou, Yushy, Parvizi, Javad
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - administration & dosage
Antibiotics
Archives & records
Arthroplasty, Replacement - adverse effects
Arthroplasty, Replacement - methods
Bone Cements
Humans
Infections
Joint surgery
Kidneys
Mechanical properties
Medicine
Medicine & Public Health
Orthopaedic Surgery
Orthopedics
Polymethyl Methacrylate
Prostheses
Prosthesis-Related Infections - prevention & control
Surgeons
Trauma
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Summary:This review evaluates the decision-making framework for using antibiotic-loaded cement (ALC) in the management of prosthetic joint infection (PJI). Drawing on available literature, we offer orthopaedic surgeons a guided discussion on several critical considerations. First, we explore the impact of antibiotic-loading on the mechanical properties of polymethylmethacrylate (PMMA) cement, assessing both strength and durability. We then explore the optimal antibiotic dosage to load into cement, aiming to achieve effective local concentrations for infection control without compromising mechanical stability. Furthermore, we explore how cement and antibiotic properties affect the overall antibiotic elution characteristics of ALC. Finally, we discuss risks of systemic toxicity, particularly acute kidney injury, when using ALC. The principal goal in this review is to provide a balanced approach based on best available evidence that optimises antibiotic elution from ALC whilst minimising potential harms associated with its use.
ISSN:1434-3916
0936-8051
1434-3916
DOI:10.1007/s00402-024-05328-z