What is the role of antibiotic-impregnated cement in arthroplasty, and what are its limitations?

• A. Provides local antimicrobial prophylaxis in the cement mantle; limitations include resistance risk, potential toxicity, and not a substitute for systemic antibiotics.
• B. Replaces systemic antibiotics entirely.
• C. Has no risk of toxicity.
• D. Should be used in all joints regardless of infection risk.

Answer: (B)

Antibiotic-impregnated cement provides high local concentrations of antibiotics right at the prosthesis–bone interface, acting as a targeted way to reduce infection risk during and after arthroplasty. This local prophylaxis helps cover the surgical site where bacteria might invade the implant, and it’s especially useful in spacer strategies during infection management.

But it’s not a substitute for systemic antibiotics. The cement’s antibiotic dose and elution decrease over time, so it may not control deep or established infections and cannot reach areas beyond the immediate cement mantle. There’s also a risk of promoting resistant organisms if local levels fall into subtherapeutic ranges, and systemic absorption can cause toxicity in some patients. Additionally, loading cement with antibiotics can affect its mechanical properties if done excessively, and the choice of antibiotic must be compatible with cement and heat-stable to survive curing. In short, antibiotic-impregnated cement is an adjunct for local prophylaxis, not a replacement for systemic antibiotic therapy.