Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a miracle weapon priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a one size fits all philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient- and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibiotic-loaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.

Automated summary

With the increase in global arthroplasty procedures, prosthetic joint infection cases are expected to rise, emphasizing the importance of strict rules and effective preventive strategies. Prioritizing evidence-based measures such as preoperative optimization for high infection risk patients, adherence to hygiene rules, and implementation of effective antibiotic prophylaxis is crucial in countering this trend. Adjusting antibiotic prophylaxis protocols to major infection risks and focusing on local application methods like dual antibiotic-loaded bone cement in risk situations have shown advantages in reducing prosthetic joint infections.