Prosthetic Joint
Infection (PJI) causes significant morbidity and mortality for patients globally. Delivery of
antibiotics to the site of
infection has potential to improve the treatment outcomes and enhance biofilm eradication. These
antibiotics can be delivered using an intra-articular
catheter or combined with a carrier substance to enhance pharmacokinetic properties. Carrier options include non-resorbable
polymethylmethacrylate (
PMMA)
bone cement and resorbable
calcium sulphate,
hydroxyapatite, bioactive glass, and
hydrogels.
PMMA allows for creation of structural spacers used in multi-stage revision procedures, however it requires subsequent removal and
antibiotic compatibility and the levels delivered are variable.
Calcium sulphate is the most researched resorbable carrier in PJI, but is associated with
wound leakage and hypercalcaemia, and clinical evidence for its effectiveness remains at the early stage.
Hydrogels provide a versatile combability with
antibiotics and adjustable elution profiles, but clinical usage is currently limited. Novel anti-biofilm
therapies include bacteriophages which have been used successfully in small case series.