Antibiotic-loaded bone cement
Periprosthetic infection is the most feared complication in total hip and knee replacement. The infection usually leads to a complete failure of the joint replacement, resulting in a long series of operative procedures, great discomfort for the patient and heavy costs.1
Infections occur because of the high affinity of many germs to the surface of implants. Once settled, germs are less sensitive to antibiotics, as they are covered with a “slime” preventing them from attacks from the host defence mechanism. This renders treatment with systemic antibiotics ineffective.
A solution to the problem is preventing the settlement of germs. The use of antibiotic-loaded bone cements allows for high local concentrations of antibiotics to be administered to the areas surrounding the implant, protecting the implant from the settling of germs. Moreover, antibiotic levels in the serum are sufficiently low so as to avoid causing side effects.
The addition of antibiotics to bone cement was undertaken at the beginning of the 1970s by Buchholz,2 from the Endo-Klinik in Hamburg. His idea was to add antibiotics to the cement in order to reduce the incidence of infection, which was high at that time. Using gentamicin in combination with PMMA cement, it was found that the combination with gentamicin was stable and offered a suitable spectrum of antibiotic activity.
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