Antibiotic-loaded bone cement in orthopedic infections: Review of evidence and clinical applications

Background Orthopedic infections, including prosthetic joint infections (PJI), chronic osteomyelitis, and infected nonunions, …represent some of the most challenging complications in orthopedic surgery. Conventional systemic antibiotics often struggle to achieve effective concentrations at the infection site, particularly in areas of poor vascularity or biofilm formation. Objective This review aims to provide an in-depth analysis of antibiotic-loaded bone cement (ALBC) as a local antibiotic delivery strategy in the treatment and prevention of orthopedic infections. Methods A literature search (2009–2024) was conducted across PubMed, Scopus, and ScienceDirect, focusing on English-language studies on the use of antibiotic-loaded bone cement (ALBC) for prevention and treatment of infection. Results ALBC enables sustained, high local antibiotic concentrations while minimizing systemic exposure. It has demonstrated efficacy in various orthopedic scenarios, including two-stage exchange arthroplasty, spacer implantation, and management of infected bone defects. Factors such as cement composition, choice of antibiotic, and cement porosity significantly influence elution dynamics and clinical effectiveness. Conclusion ALBC is a valuable adjunct in orthopedic infection management, offering targeted antimicrobial activity and biofilm penetration. Further research into optimal formulations, bioresorbable alternatives, and standardized protocols is warranted to maximize its therapeutic potential while minimizing complications.