Trowels and Tribulations: Review of Antimicrobial‐Impregnated Bone Cements in Prosthetic Joint Surgery

Abstract

Antimicrobial-impregnated bone cement (AIBC) is a staple of contemporary orthopedic surgery and has been used to either treat or prevent prosthetic joint infection. Applied intraoperatively during primary arthroplasty or prosthetic joint exchange, this drug-delivery vehicle has become a popular means of maximizing drug concentrations within a joint space while minimizing systemic exposure. Antimicrobial characteristics conducive to cement loading include availability of a crystalline powder formulation, molecular characteristics, minimal impact on cement integrity, and other variables promoting drug elution. Antimicrobials most commonly incorporated into cements are vancomycin and aminoglycosides, usually in combination due to synergistic antibacterial activity and enhanced cement elution. Other classes include the β-lactams, lipopeptides, oxazolidinones, and antifungals. With the exception of several commercially available AIBCs, most products are compounded extemporaneously without a formal safety or efficacy assessment. Few randomized controlled trials have been conducted to assess the benefit or optimal use of these cement preparations, and variable methodology renders cross-study comparison challenging. Given the lack of standardization and multidisciplinary oversight often seen with practical AIBC use, additional data are needed. This review presents information intended to guide AIBC preparation, selection, dosing, and safe use. In addition, opportunities for best practice development, antimicrobial stewardship, and future research are discussed.

One-Stage Exchange Arthroplasty for Fistulizing Periprosthetic Joint Infection of the Hip: An Effective Strategy

“…When used, cement was never antibiotic-loaded in our practice, and prostheses were mostly cementless. Overall, the literature still lacks an appropriately sized randomized clinical trial to better support the use of antibiotic-loaded cement, which still remains a matter of debate ( 47 – 49 ).…”

A call for action to the biomaterial community to tackle antimicrobial resistance

“…Copper, gold, magnesium, zinc and their oxides have been successfully mixed with bone cements to confer antimicrobial properties, while graphene, paraben, quaternary amine monomers or chitosan are some of the more common nonmetallic antimicrobial additives. 227,267 Nevertheless, the clinical relevance of these technologies is diminished by the limited biological assessment available in vitro, with little immune response, hemocompatibility or genotoxicity studies available in most manuscripts. Thus, there is a need to develop more fundamental work on promising antimicrobial agents while revisiting old and over simplistic in vitro testing methods for the development, screening and implementation of new therapies.…”

Computational Study on Interfacial Interactions between Polymethyl Methacrylate-Based Bone Cement and Hydroxyapatite in Nanoscale

“…Among the BC materials, poly (methyl methacrylate) (PMMA)-based organic BC is exceptionally light and flexible compared with inorganic cement materials, and its simple fabrication enables wide and universal applications. PMMA-based BC is largely composed of two parts: an MMA liquid and a PMMA powder [1][2][3]. In an actual surgical environment, these two parts are mixed in a bowl by stirring with a sterilized stick until a high-viscosity liquid is obtained.…”