title: Infection of orthopedic implants and the use of antibiotic-loaded bone cements. A review.
abstract: Infections by bacteria are a serious complication following orthopedic implant surgery, that can usually only be cured by removing the implant, since the biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. Over the past few decades, attempts have been made to prevent and cure orthopedic implant infections by incorporating antibiotics in polymethylmethacrylate bone cements, in primary and revision surgery. However, the clinical efficacy of antibiotic-releasing bone cements is not accepted by all and the long-term exposure to low doses from antibiotic-releasing bone cements in patients is strongly related to the emerging threat of antibiotic resistance in medicine today. In this article, we start by reviewing the mechanisms governing the formation of an infectious biofilm on orthopedic implant materials, the release mechanisms and properties of clinically-used, antibiotic-loaded bone cements. The clinical efficacy of antibiotic-loaded bone cements is evaluated analyzing separatedly the prophylactic and therapeutic uses of these products.
authors.affiliation: Department of Orthopedic Surgery, University Hospital Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van de Belt
authors.forename: D
authors.initials: D
authors.lastname: Neut
authors.forename: W
authors.initials: W
authors.lastname: Schenk
authors.forename: J R
authors.initials: JR
authors.lastname: van Horn
authors.forename: H C
authors.initials: HC
authors.lastname: van der Mei
authors.forename: H J
authors.initials: HJ
authors.lastname: Busscher
mesh_terms: D019072:Antibiotic Prophylaxis / Q000379:methods*; D001672:Biocompatible Materials; D018441:Biofilms; D001843:Bone Cements; D005500:Follow-Up Studies; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011322:Primary Prevention / Q000379:methods; D019736:Prostheses and Implants / Q000382:microbiology*; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012680:Sensitivity and Specificity
chemical_list: D001672:Biocompatible Materials; D001843:Bone Cements