Abstract
Polymethylmethacrylate (PMMA) also referred as (acrylic) bone cement is a non-degradable biomaterial that has been used in clinical orthopedic practice for several decades. PMMA can be used in a plain formulation, but is often used in an antibiotic-loaded formulation in (primary and revision) arthroplasty and in treatment of orthopedic infections as prosthetic joint infections (PJI) and chronic osteomyelitis. In treatment of PJIs antibiotic-loaded PMMA is often used as a carrier material for local antibiotic delivery in addition to treatment with systemic antibiotics. In this case, the antibiotic-loaded PMMA is often used as a spacer or as a bead chain. Since the introduction of PMMA as an antibiotic carrier there is a tremendous amount of scientific and clinical papers published, which studied numerous different aspects of antibiotic-loaded PMMA. This paper will review the research regarding basic principles of antibiotic-loaded PMMA as mechanism of action, antibiotic-release capacities, choice of antibiotics and influences on mechanical properties of PMMA. Subsequently, concerns regarding the application of antibiotic-loaded PMMA, biofilm formation, antibiotic resistance and local or systemic toxicity will be discussed. In addition to these subjects, the role of antibiotic loaded PMMA in clinical treatment of PJIs and chronic osteomyelitis is discussed in the final part of this paper.
Highlights
Bacterial infections are one of the most devastating complications in the field of orthopedic surgery
Infections related to implants e.g., cases of infection in total joint arthroplasty (TJA), or infections related orthopedic traumatology where implants are used for bone fixation are burdensome and difficult to treat
These concerns there is no clinical evidence that using antibiotic loaded PMMA in prophylaxis or treatment of prosthetic joint infections (PJI) and chronic osteomyelitis leads to an increase of antibiotic resistance
Summary
Bacterial infections are one of the most devastating complications in the field of orthopedic surgery. Not solely the absolute numbers of PJIs are increasing, and the relative infection rates are increasing (Dale et al, 2009) These numbers are rising due to the aging population and a higher demand for joint replacements due to higher activity levels of these patients. PJIs can be treated by debridement surgery, antibiotics, irrigation and implant retention (DAIR), a onestage replacement surgery, or a two stage replacement surgery depending on the duration of infection, the type of causative pathogen, status of soft tissues and the health status of the patient (Zimmerli et al, 2004). Polymethylmethacrylate (PMMA), called bone cement or acrylic bone cement, is a widely accepted carrier material for this local antibiotic delivery and is able to exceed the required MIC. This paper will highlight basic principles of antibiotic-loaded PMMA in treatment of PJIs and chronic osteomyelitis and its effect on biofilm formation
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
