Antimicrobial Materials in Arthroplasty

With an increase in the number of total joint arthroplasty procedures being performed, the number of surgical site infections (SSI) and peri-prosthetic joint infections (PJI) are also expected to increase. In addition to portending significant morbidity and mortality, the growing number of prosthetic associated infections also presents a significant social and economic burden. There are current antimicrobial resistance strategies available for clinical use and more are being developed and are in the laboratory development and testing phases. However, resistance to treatment include limited implant host interface vascularity that contributes to the inability of systemically administered antibiotics to effectively reach and exert a full effect where most needed. Recognition of the limitation of systemic antibiotics and the growing problem presented by PJI have led to more recent efforts focused on local antimicrobial control at or around surgically implanted materials. Current and developing methods of achieving prophylactic local antimicrobial control in arthroplasty include using antibiotic loaded bone cement, intrawound antibiotic powders, antiseptic lavages, biocompatible antimicrobial delivery devices and coatings, and modified implants.