Use of Antibiotic Loaded Biomaterials for the Management of Bone Prosthesis Infections: Rationale and Limits

Abstract

Background: Periprosthetic joint infection still represents a challenging issue for the orthopedic community. In the United States approximately a million joint arthroplasties are performed each year, with infection rates ranging from 1 to 2%: revisions has significant implications on health care costs and appropriate resource management. The use of locally applied antibiotics as a prophylaxis measure or as a component of the therapeutic approach in primary or revision surgery is finalized at eliminating any microorganism and strengthening the effectiveness of systemic therapy. Objective: The present review of clinical and preclinical in vivo studies tried to identify advantages and limitations of the materials used in the clinical orthopedic practice and discuss developed biomaterials, innovative therapeutic approaches or strategies to release antibiotics in the infected environment. Methods: A systematic search was carried out by two independent observers in two databases (www.pubmed.com and www.scopus.com) in order to identify pre-clinical and clinical reports in the last 10 years. Results: 71 papers were recognized eligible: 15 articles were clinical studies and 56 in vivo studies. Conclusion: Polymethylmethacrylate was the pioneer biomaterial used to manage infections after total joint replacement. Despite its widespread use, several issues still remain debated: the methods to combine materials and antibiotics, the choice of antibiotics, releasing kinetics and antibiotics efficacy. In the last years, the interest was directed towards the selection of different antibiotics, loaded in association with more than only one class and biomaterials with special focus on delivery systems as implant surface coatings, hydrogels, ceramics, micro-carriers, microspheres or nanoparticles.