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

Fraval A., Zhou Y., PARVİZİ J.

ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, cilt.144, sa.12, ss.5165-5175, 2024 (SCI-Expanded) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 144 Sayı: 12
  • Basım Tarihi: 2024
  • Doi Numarası: 10.1007/s00402-024-05328-z
  • Dergi Adı: ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, BIOSIS, CINAHL, EMBASE, MEDLINE, SportDiscus
  • Sayfa Sayıları: ss.5165-5175
  • Anahtar Kelimeler: Antibiotic cement, Prosthetic joint infection
  • Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Hayır

Özet

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.