Purpose of Technology: Antibiotic bone cement (ABC) is a type of curable polymethacrylate preparation created by adding various antibiotic medications to plain, nonmedicated bone cement. This material is used to fix the components of joint replacement devices or fractured bones. It may also be used as a delivery system for antibiotics to prevent or treat many types of deep musculoskeletal infections. Most commonly, ABC is used to treat infected total joint prostheses as part of revision arthroplasty, but its use as antibiotic prophylaxis in primary joint arthroplasty is increasing.
Rationale: ABC at the arthroplasty site or site of bone infection may be useful in maintaining a locally high level of antibiotic drug concentration. These high levels may not be achieved without the potential systemic toxicity associated with intravenous administration.
Controversy: Controversial issues related to the clinical use of ABCs include the safety and effectiveness of ABCs compared with other fixation methods, optimal antibiotic choice and dose, optimal cement preparation technique, cost-effectiveness of ABCs, the appropriate use of ABC in a prophylactic setting, antimicrobial resistance, and patient selection (i.e., which patients might benefit the most from the treatment).
Relevant Questions:
- Is ABC effective in preventing infection in primary hip or shoulder arthroplasty?
- Is ABC effective in treating or preventing recurrence of infection in revision hip arthroplasty?
- Is ABC effective for preventing or treating musculoskeletal infections related to other orthopedic indications (e.g., trauma or bone disease)?
- How does ABC compare with alternative interventions for prevention or treatment of infection?
- What harms and complications are associated with ABC? Are the rates of these harms different from those experienced with alternative treatments?
- Have definitive patient selection criteria been established for the use of ABC?
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