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Microbial resistance related to antibiotic-loaded bone cement: a historical review

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The use of antibiotic-loaded bone cement (ALBC) has a range of indications for use in orthopaedics. It has the advantage of delivering high loads of antibiotics to a targeted site, thereby avoiding the side effects associated with systemic administration. However, there is concern that the use of ALBC may precipitate the development of antibiotic-resistant bacteria.

Methods

This review focuses on (1) the published research using both animal and human models examining the association between ALBC and the induction of microbial resistance (2) the mechanisms by which antimicrobial resistance develop (3) the research pertaining to specific classes of antibiotics commonly used in orthopaedic practice (4) the recent developments in calcium sulphate beads, nanoparticles and chitosan, as alternative antimicrobial treatments for periprosthetic joint infections.

Conclusion

The literature for and against a link between ALBC and the development of microbiological resistance is reviewed and presented. It is concluded that further research is needed to develop a defined set of indications for the use of ALBC in the management of periprosthetic joint infection. In addition, further research into alternative antimicrobial therapies in this area should be encouraged.

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Abbreviations

A-CSs:

Antibiotic-loaded cement spacers

ALBC:

Antibiotic-loaded bone cement

HACC:

Hydroxypropyltrimethy ammonium chloride chitosan

IV:

Intravenous

MRSA:

Methicillin-resistant Staphylococcus aureus

PJI:

Periprosthetic joint infection

PMMA:

Polymethylmethacrylate

SIGN:

Scottish intercollegiate guidelines network

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Authors’ contributions

LW performed the literature search and wrote the first draft of the review. RH offered background information on the topic of microbial resistance related to antibiotic-loaded bone cement. PB and DD edited the review until the final draft was agreed upon. All authors read an approved the final manuscript

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Authors and Affiliations

  1. James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

    Lucy C. Walker & Paul Baker

  2. Northumbria Specialist Emergency Care Hospital, Northumbrian Road, Cramlington, NE23 6NZ, UK

    Richard Holleyman

  3. Freeman Hospital, Freeman Road, High Heaton, Newcastle-upon-Tyne, NE7 7DN, UK

    David Deehan

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  1. Lucy C. Walker
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  2. Paul Baker
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  4. David Deehan
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Correspondence to Lucy C. Walker.

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No funding has been received for this study.

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Ethical approval was not obtained because this study was a literature review.

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Walker, L.C., Baker, P., Holleyman, R. et al. Microbial resistance related to antibiotic-loaded bone cement: a historical review. Knee Surg Sports Traumatol Arthrosc 25, 3808–3817 (2017). https://doi.org/10.1007/s00167-016-4309-5

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  • DOI: https://doi.org/10.1007/s00167-016-4309-5

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