2023, Vol. 27 ›› Issue (3): 470-477

Advantages and problems of antibiotic-loaded bone cements for bone and joint infections

Han Tao1, Hao Jianqiang1, Li Wenbo2, Shi Jie2, Gao Qiuming2   

Abstract: BACKGROUND: Polymethyl methacrylate bone cement has good stability, plasticity and space-occupying ability, and is currently the most commonly used antibiotic carrier in clinical practice. Topical application of antibiotic-loaded bone cements can prevent, delay or even eradicate infections in the skeletal muscular system, and is currently a common means of addressing the challenge of bone and joint infections. However, the addition of antibiotics can significantly affect the mechanical properties of polymethyl methacrylate bone cement and has the potential to cause adverse reactions. In addition, some scholars found that the antibiotic release rate of antibiotic-loaded bone cements is very low, and topical application of antibiotic-loaded bone cements does not effectively destroy bacteria and has the potential to cause bacterial resistance. Therefore, they questioned the effectiveness of antibiotic-loaded bone cements in controlling infections, and it has been widely debated.
OBJECTIVE: To review the advantages and problems of antibiotic-loaded bone cements and to summarize the precautions for its clinical use.
METHODS: The computerized searches were conducted on PubMed, Wanfang and CNKI databases using “antibiotic-loaded bone cements, polymethyl methacrylate, PMMA; bone cements, anti-bacterial agents, bone and bones, joints, elution, release, and mechanical” as the search terms in Chinese and English to search the relevant literature from January 1, 2017 to December 31, 2021. After excluding the literature that was not related to the article content, poorly innovative and duplicated, 68 papers were finally included for review.
RESULTS AND CONCLUSION: Currently, antibiotic-loaded bone cements are one of the best options for the treatment of bone and joint infections. As research on antibiotic-loaded bone cements continues, many new methods have emerged to improve their antibiotic release, antimicrobial capacity and mechanical properties, and their use in clinical practice has also expanded. However, there are still many issues that have not been solved and further research is needed, such as the selection of antibiotics, dosage, and the optimal mixing method. In addition, the development and local application of modified materials and antibiotic substitutes that can be incorporated into polymethyl methacrylate bone cement are expected to solve the problem of bacterial resistance. It is believed that with the development of medicine, pharmacology and biomaterials science, polymethyl methacrylate bone cement will be more widely used in clinical practice.
Key words: polymethyl methacrylate, antibiotic-loaded bone cements, bone and joint infection, elution, mechanical strength, modification, drug resistance, adverse effect, review