Pmma Bone Cement: What Is the Role of Local Antibiotics

Due to its primary fixation purpose antibiotic loaded bone cement (ALBC) has been classified as a class III medical device according to the CE standard for the fixation of primary or revision implants. Because of the high initial release of local antibiotics into the joint cavity, ALBC has also been successfully used for decades for prophylactic reasons aimed at prevention of bacterial colonisation of the prosthesis. Gentamicin is generally chosen because of the controlled diffusion out of the cement mantle and the broad spectrum bactericidal effect against a wide variety of gram-positive or gram-negative bacterial contaminants. However, in times of increasing bacterial resistance, empiric use of antibiotics (AB) has become a controversial discussion point, and it appears justified to ask the following question: Does the addition of one or several AB to bone cement really add benefit to the common practice of systemic AB prophylaxis and to AB treatment protocols in cases of already established prosthetic joint infections?