The Role of Antibiotic Loaded Bone Cement in the Primary Arthroplasty

Prosthetic joint infection (PJI) is one of the most devastating complications that can occur following total joint arthroplasty. The severity of these complications can result in multiple revision surgeries, great physical/emotional pain to the patient and extensive hospital costs (the average costs to treat PJI can exceeded $100,000). As a preventative measure against PJI, antibiotics are often incorporated into acrylic bone cement in order to deliver high drug concentrations directly to the implant site, without inducing systemic side effects.

National joint registry databases have shown that the use of antibiotic-loaded bone cement (ALBC) is an effective measure against the development of PJI. Despite this, concern has been raised over the lack of antibiotic release efficiency; only 10% of the incorporated antibiotic is released from the cement. In response, various methods have been introduced that aim to increase antibiotic elution from acrylic cement. Unfortunately, the majority of these techniques are detrimental to the cement’s mechanical properties and thus render them useless for implant fixation in primary arthroplasty.

The primary goal of this research therefore is to investigate the use of filler materials that can be added to bone cement to increase antibiotic elution while preserving, or even enhancing, the cement’s mechanical properties. Current research is focused on a variety of fillers that include soluble/non-soluble materials and span multiple length scales (from micro to nano). Primary measures of interest include, but are not limited to, static mechanical properties (compression, bending), fatigue performance, fracture toughness, dynamic properties (tanδ, storage/loss modulus), antibiotic elution kinetics, polymerization kinetics and handling characteristics.

Aspects of this project are being conducted in collaboration with Dr. Matthew Squire (University of Wisconsin School of Medicine and Public Health) and Dr. Jill Meyer (University of Wisconsin-Milwaukee).

Infected knee prosthesis. Image courtesy of Dr. Matthew Squire

Infected knee prosthesis. Image courtesy of Dr. Matthew Squire