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Review
. 2019 Jul 25:10:1626.
doi: 10.3389/fmicb.2019.01626. eCollection 2019.

Antibiotic-Loaded Polymethylmethacrylate Beads and Spacers in Treatment of Orthopedic Infections and the Role of Biofilm Formation

Tom A G van Vugt  1 , Jacobus J Arts  1 , Jan A P Geurts  1
Affiliations
Review

Antibiotic-Loaded Polymethylmethacrylate Beads and Spacers in Treatment of Orthopedic Infections and the Role of Biofilm Formation

Tom A G van Vugt et al. Front Microbiol. .

Abstract

Polymethylmethacrylate (PMMA) also referred as (acrylic) bone cement is a non-degradable biomaterial that has been used in clinical orthopedic practice for several decades. PMMA can be used in a plain formulation, but is often used in an antibiotic-loaded formulation in (primary and revision) arthroplasty and in treatment of orthopedic infections as prosthetic joint infections (PJI) and chronic osteomyelitis. In treatment of PJIs antibiotic-loaded PMMA is often used as a carrier material for local antibiotic delivery in addition to treatment with systemic antibiotics. In this case, the antibiotic-loaded PMMA is often used as a spacer or as a bead chain. Since the introduction of PMMA as an antibiotic carrier there is a tremendous amount of scientific and clinical papers published, which studied numerous different aspects of antibiotic-loaded PMMA. This paper will review the research regarding basic principles of antibiotic-loaded PMMA as mechanism of action, antibiotic-release capacities, choice of antibiotics and influences on mechanical properties of PMMA. Subsequently, concerns regarding the application of antibiotic-loaded PMMA, biofilm formation, antibiotic resistance and local or systemic toxicity will be discussed. In addition to these subjects, the role of antibiotic loaded PMMA in clinical treatment of PJIs and chronic osteomyelitis is discussed in the final part of this paper.

Keywords: antibiotic loaded acrylic cement spacer; antibiotic loaded bone cement; gentamicin beads; osteomyelitis; polymethylmethacrylate; prosthetic join infection.

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Figures

FIGURE 1
FIGURE 1
Examples of the application of antibiotic loaded Polymethylmethacrylate in the orthopedic practice. In figure on the left side, solely antibiotic loaded PMMA-beads are used in treatment of infected TKP. In the middle beads and a (hand-molded) spacer are used for treatment of an infected TKP. In the figure on the right side, PMMA-beads are used in treatment of chronic osteomyelitis.
FIGURE 2
FIGURE 2
(A) The gentamicin concentrations in exudate are shown over time in two different cases. Patient A had an infected THP, treated with 300 gentamicin beads at first surgery and a spacer at the second surgery. Patient B had an infected TKP, treated with 60 beads and 1 spacer at the first surgery and 2 spacers after the second surgery. (B) X-ray images of treatment of patient A. (C) Images of the treatment of patient B.
FIGURE 3
FIGURE 3
Different generations of hip and knee spacers. (A) Hand molded knee spacer (first generation). (B) Spacer made with pre-fabricated molds for hip and knee (second generation) (Tecres, Italy is the owner of the copyrights and all other intellectual property rights in relation to this picture). (C) Mobile bearing spacer (third generation) (Biomet Stage One Select system; Zimmer Biomet is the owner of the copyrights and all other intellectual property rights in relation to this picture).
See this image and copyright information in PMC

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