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Mixing Antibiotics with Joint Cement to Reduce Infection with Joint Replacement Surgery

Doctors have the option of using acrylic cement when replacing joints. The cement binds the implant to the surrounding bone. The implant has to be able to take loads that are placed on the limb. It is thought that the cement helps the new joint to share these loads with the bone.

Any surgery increases the risk of infection. This is especially true during joint replacement surgery. Why not mix an antibiotic with the cement? This is exactly what doctors did back in 1970. How and when doctors use this concoction raises new questions.

To find answers, doctors of the Musculoskeletal Research Center at New York University reviewed the use of this form of treatment. They found that there isn't an accepted way to use antibiotics in joint implant cement. Some doctors always use it, while most save it for joints that have to be operated on a second time (called joint revision surgery). Revision surgery is often recommended if the implant comes loose or gets infected.

There is concern about the regular use of antibiotics. When bacteria come in contact with these drugs, they can change and become resistant to the drug. Besides bacterial resistance, other problems can occur with the use of this product. The antibiotic can cause the cement to lose its strength. Some antibiotics prevent the bone, ligaments, and other soft tissues from healing. Researchers are trying to find the best mixture that releases the drug slowly and won't slow down healing after joint replacement surgery.

The mixture of antibiotics with joint cement isn't needed for every joint replaced. Future cement products may be stronger with a slow release of antibiotic over time. The goal is to find an antibiotic that lowers the infection rate and doesn't have to be removed.

References: Thomas N. Joseph, MD, et al. Use of Antibiotic-Impregnated Cement in Total Joint Arthroplasty. In Journal of the American Academy of Orthopaedic Surgeons. January/February 2003. Vol. 11. No. 1. Pp. 38-47.

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