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Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

Authors
  • Berberich, Christof Ernst
  • Josse, Jérôme
  • Laurent, Frédéric
  • Ferry, Tristan
Type
Published Article
Journal
World Journal of Orthopedics
Publisher
Baishideng Publishing Group Co (World Journal of Orthopedics)
Publication Date
Mar 18, 2021
Volume
12
Issue
3
Pages
119–128
Identifiers
DOI: 10.5312/wjo.v12.i3.119
PMID: 33816139
PMCID: PMC7995342
Source
PubMed Central
Keywords
Disciplines
  • Minireviews
License
Green

Abstract

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a “miracle weapon” priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a “one size fits all” philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient- and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibiotic-loaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.

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