Progress of antibiotic-loaded bone cement in joint arthroplasty

Abstract

Bone cement, consisting of polymethyl methacrylate, is a bioinert material used for prothesis fixation in joint arthroplasty. To treat orthopedic infections, such as periprosthetic joint infection, antibiotic-loaded bone cement (ALBC) was introduced into clinical practice. Recent studies have revealed the limitations of the antibacterial effect of ALBC. Moreover, with the increase in high infection risk patients and highly resistant microbes, more researches and modification of ALBC are required. This paper reviewed latest findings about ALBC for most popular and destructive pathogens, summarized the influence of antibiotic kind, drug dosage, application method, and environment towards characteristic of ALBC. Subsequently, new cement additives and clinical applications of ALBC in joint arthroplasty were also discussed.

Multifunctional magnesium-organic framework doped biodegradable bone cement for antibacterial growth, inflammatory regulation and osteogenic differentiation

“…According to previous studies, antibiotic drugs are the primary antimicrobial agents used clinically. 53,54 Antibiotics had the potential to cause cytotoxicity, and overusing them increased the risk of developing antibiotic resistance, which reduced their effectiveness against bacteria. [55][56][57] The Mg-MOF bone cement not only possessed remarkable antibacterial properties, but it could encourage osteoblast proliferation and differentiation when compared to the addition of antibiotics such as vancomycin, tobramycin and gentamicin to conventional cement.…”

Regulating the release of Mg-MOF from degradable bone cement by coating Mg-MOF with oxidized dextran/gelatin

“…However, antibiotics have potential cytotoxicity and bacterial resistance in long-term use. 45,46 Compared with antibiotics, OD/Gel@Mg-MOF had excellent antibacterial properties, which could greatly reduce the emergence of bacterial resistance, and also had good cell compatibility. At the same time, the addition of antibacterial silver, natural compounds (tannic acid) or antibiotics (gentamicin, vancomycin, and tobramycin) to bone cement often destroyed structural stability of bone cement and reduced its mechanical properties.…”

Long-Term Prevention of Arthroplasty Infections via Incorporation of Activated AgNbO3 Nanoparticles in PMMA Bone Cement

“…Another drawback related to the use of antibiotics is its influence on the mechanical properties of the PMMA. 23 Antibiotic molecules are radical scavengers, which may inhibit polymerization during the synthesis of PMMA. With drug particles gradually being eluted from the cement over time, the remaining gaps become weak points and lead to the initiation of cracks.…”

“…This prolonged exposure to subinhibitory levels of antibiotics at the surface of the cement can pose the risk of stimulating the emergence of antibiotic resistant strains. Another drawback related to the use of antibiotics is its influence on the mechanical properties of the PMMA . Antibiotic molecules are radical scavengers, which may inhibit polymerization during the synthesis of PMMA.…”