Antibiotic Release Enhancement Methods for Antibiotic-Loaded PMMA Bone Cement for Periprosthetic....

Background: Peri-prosthetic joint infection (PJI) is generally recognised as the most dangerous and difficult complication of complete joint arthroplasty. As a result, many aspects of this issue have been studied over the years, including methods to improve arthroplasty resistance to PJI by improving the profile of antibiotic release from an antibiotic-loaded poly(methyl methacrylate) bone cement (ALBC) when it is used to anchor the prosthesis to the bone.

The aim was to perform a systematic and critical analysis of the literature on all aspects of enhancement methods in order to decide which were the most successful.

Methodology: Related English-language papers published in the open literature between January 1985 and August 2020 were identified using keywords such as PJI, ALBC, and cemented arthroplasties, as well as publicly-available databases such as Google Scholar and MEDLINE.

Findings: A number of enhancement indices were determined based on the findings presented in the studies. Increases in 1) the cumulative amount of antibiotic released during a release test, 2) the duration of the burst phase of antibiotic release, 3) the time at the start of the exhaustion phase of antibiotic release, and 4) the effectiveness of the released antibiotic against microorganisms commonly found in PJI cases (herein referred to as “clinically-relevance microorganisms”). The most effective enhancement process, based on these measured values, is to add fillers to the cement powder.

Summary: A variety of enhancement techniques were used, including the addition of fillers to the cement powder and ultrasonication of the cement specimen. The literature has a number of weaknesses, despite the fact that several findings were published in the studies examined.

Among these are a lack of studies assessing the antibiotic's efficacy against clinically important bacterial strains and biofilm formation. Expositions of these weaknesses contribute to the discovery of possible research areas, such as studies of antibiotic enhancement from ALBCs with novel architecture and the relationship between an enhancement process and quorum quenching (a mechanism that is postulated to be involved in resistance to biofilm formation).

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