Antibiotic cement coating in orthopedic surgery: a systematic review of reported clinical techniques

Abstract

Background Antibiotic-containing cement and bone graft substitute-coated orthopedic implants provide the advantages of simultaneous local antibiotic delivery and internal stable fixation, aiding in both infection eradication and osseous healing. Standardized protocols pertaining to implant coating techniques in various clinical and particularly intraoperative settings are scarce, and available literature is limited. This systematic review aims to provide a summary of the available current literature reporting on custom-made coating techniques of orthopedic implants, indications, outcomes, and associated complications in clinical use. Methods A systematic search of the literature in PubMed, Medline, Embase, and Cochrane Library databases was performed in accordance with PRISMA guidelines. Articles reporting specifically on custom-made coating techniques of orthopedic implants in a clinical setting were eligible. Results A total of 41 articles with a cumulative total number of 607 cases were included. Indications for treatment mostly involved intramedullary infections after previous plate osteosynthesis or nailing. A variety of implants ranging from intramedullary nails, plates, wires, and rods served as metal cores for coating. Polymethylmethacrylate (PMMA) bone cement was most commonly used, with vancomycin as the most frequently added antibiotic additive. Chest tubes and silicone tubes were most often used to mold. Common complications are cement debonding and breakage of the metallic implant. Conclusion Adequate coating techniques can reduce the burden of treatment and be associated with favorable outcomes. Lack of general consensus and heterogeneity in the reported literature indicate that the perfect all-in-one implant coating method is yet to be found. Further efforts to improve implant coating techniques are warranted. Level of evidence III.

Efficacy of Infection Eradication in Antibiotic Cement-Coated Intramedullary Nails for Fracture-Related Infections, Nonunions, and Fusions

“…ACCINs continue to gain attention as a viable solution for the treatment of FRIs, infected long bone nonunions, and arthrodeses without an external fixator [ 9 ]. The basic principles for eradicating osteomyelitis include bone debridement, dead space management, antibiotic delivery, and bone stability.…”

Mg-, Zn-, and Fe-Based Alloys With Antibacterial Properties as Orthopedic Implant Materials

“…Strategies for IAI mainly start from three aspects: 1) preventing the initial adhesion of bacteria, 2) destroying the biofilm that is just starting to form, and 3) destroying the mature biofilm. Many research studies have been devoted to improvements in antibiotic therapy, such as bone cement ( Ismat et al, 2021 ), biopolymers ( Kasza et al, 2021 ), ceramic materials ( Cyphert et al, 2021 ), hydrogels ( Garg et al, 2021 ), and nanomaterials ( Keskin et al, 2021 ; Nag et al, 2021 ). They are designed as local drug delivery vehicles or coatings.…”

Treatment of Periprosthetic Joint Infection and Fracture-Related Infection With a Temporary Arthrodesis Made by PMMA-Coated Intramedullary Nails – Evaluation of Technique and Quality of Life in Implant-Free Interval

“…All implants of the T2 humeral nailing system are cannulated and made of Type II anodized titanium alloy (Ti6AL4V) (https://www.stryker.com/us/en/trauma-andextremities/products/t2-standard-humeral-nail.html). Different other osteosynthesis materials are generally suitable for internal stabilization (21). Manufactured intramedullary humerus nails, however, have several advantages compared with simple smooth intramedullary rods.…”

“…Also, other techniques for preventing cement debonding have been reported, such as using threaded cores or roughening the nail surface before coating to enhance the adherence of cement (41). To note, no specific guidelines exist with regard to the techniques used to cement-coat implants in a custom-made fashion, and there is a considerable heterogeneity in the reported literature, making it challenging to arrive at a general consensus (21). In the same way, the superiority of reinforced versus unreinforced implants with regard to post-operative complications has yet be proven due to the lack of randomized comparative studies.…”