Background: Periprosthetic joint infection still represents a challenging issue
for the orthopedic community. In the United States approximately a million joint arthroplasties
are performed each year, with infection rates ranging from 1 to 2%: revisions has
significant implications on health care costs and appropriate resource management. The
use of locally applied antibiotics as a prophylaxis measure or as a component of the therapeutic
approach in primary or revision surgery is finalized at eliminating any microorganism
and strengthening the effectiveness of systemic therapy.
Objective: The present review of clinical and preclinical in vivo studies tried to identify
advantages and limitations of the materials used in the clinical orthopedic practice and
discuss developed biomaterials, innovative therapeutic approaches or strategies to release
antibiotics in the infected environment.
Methods: A systematic search was carried out by two independent observers in two databases
(www.pubmed.com and www.scopus.com) in order to identify pre-clinical and clinical
reports in the last 10 years.
Results: 71 papers were recognized eligible: 15 articles were clinical studies and 56 in vivo
Conclusion: Polymethylmethacrylate was the pioneer biomaterial used to manage infections
after total joint replacement. Despite its widespread use, several issues still remain
debated: the methods to combine materials and antibiotics, the choice of antibiotics, releasing
kinetics and antibiotics efficacy. In the last years, the interest was directed towards
the selection of different antibiotics, loaded in association with more than only one
class and biomaterials with special focus on delivery systems as implant surface coatings,
hydrogels, ceramics, micro-carriers, microspheres or nanoparticles.