Antibiotic-loaded cement in orthopedic surgery: a review.

Alessandro Bistolfi,Fabrizio Galetto,Davide Deledda,Giuseppe Massazza,Enrica Verné,Sara Ferraris,Maurizio Crova,Alessandro Massè,Marta Miola

doi:10.5402/2011/290851

Abstract

Infections in orthopaedic surgery are a serious issue. Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases. Despite the widespread use of the antibiotic-loaded bone cement in orthopedics, many issues are still unclear or controversial: bacterial adhesion and antibiotic resistance, modification of mechanical properties which follows the addition of the antibiotic, factors influencing the release of the antibiotic from the cement and the role of the surface, the method for mixing the cement and the antibiotic, the choice and the effectiveness of the antibiotic, the combination of two or more antibiotics, and the toxicity. This review discusses all these topics, focusing on properties, merits, and defects of the antibiotic loaded cement. The final objective is to provide the orthopaedic surgeons clear and concise information for the correct choice of cement in their clinical practice.

Highlights

The purpose of this review is to analyze the main issues of antibiotic loaded bone cements and to comment their basic properties, main characteristics, merits, and defects
Antibiotic-loaded bone cement was developed for the treatment of infected joint arthroplasties and for prophylaxes in total joint replacement in selected cases
The results showed that Simplex-tobramycin has antibacterial activity against 98% of the tested strains of P

Summary

Introduction

The purpose of this review is to analyze the main issues of antibiotic loaded bone cements and to comment their basic properties, main characteristics, merits, and defects. It was demonstrated that bacteria have the ability to bind to the surface of biomaterials, due to specific physical and chemical properties [2, 6, 7]. The antibiotics available for the prevention and the treatment of the orthopedic infections were only a few and these antibiotics could have been ineffective against certain bacteria like staphylococci and gram-negative. The mainstay of treatment of an infected joint prosthesis is based on the removing of the implant and on the accurate toiletries around the surrounding necrotic soft and bone tissue, either in on- or two- stage technique [11,12,13]

Objectives

Methods

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Conclusion