Klin Farmakol Farm. 2017;31(4):18-24 | DOI: 10.36290/far.2017.024

Antibiotic-loaded bone cement

Michal Svoboda, Jiří Gallo, Miroslava Mrňková

Ortopedická klinika Lékařské fakulty Univerzity Palackého v Olomouci a Fakultní nemocnice Olomouc

Polymethyl methacrylate (PMMA) bone cement has been used in orthopaedic surgery in a wide spectrum of indications. Themain purpose of PMMA cement is to fix implants to the bone and to fill cavities or bone defects. Bone cement is a very successfulmaterial thanks to its perfect physical properties, such as plasticity, stability and the ability to elute antibiotics to the adjacenttissues at relatively stable rates over a long period.The concentration of antibiotics in the tissues adjacent to the antibiotic-impregnated bone cement (AIBC) is much higher than the minimalinhibitory concentrations of most bacteria. On the other hand, the serum antibiotic levels remain negligible. The elution characteristicsdepend on cement porosity, homogeneity and viscosity as well as on the volume-to-surface ratio and total dose of antibiotics.Not every antibiotic is suitable for impregnation of PMMA cement. The ideal antibiotic has a broad antibacterial spectrum andmust be bactericidal, thermally and chemically stable and available in the powder form. It must not induce allergic reactions orbacterial resistance or impair the mechanical properties of the cement.The AIBC is used in prevention and treatment of prosthetic joint infection, in treatment of osteomyelitis and infected soft tissuedefects. It is a perfect material for bone defect filling or cemented intramedullary nails.The main complications of AIBC administration are possible toxicity of antibiotics, allergic reactions and induction of antibioticresistance.There have been many experiments carried out on other substances that could be suitable for cement impregnation. Thesesubstances modify the properties of cement or the elution characteristics of antibiotics. The aim of current research is to developa new material, which would have as good properties as PMMA cement has and would be biodegradable in addition.

Keywords: antibiotic-impregnated bone cement, antibiotic-loaded bone cement, polymethyl methacrylate, infection, antibiotics, prosthetic joint infection, knee fusion, knee arthrodesis, osteomyelitis

Published: January 1, 2018  Show citation