What is the role of antibiotic-loaded bone cement in joint arthroplasty, and when is it most useful?

• A. Delivers high systemic antibiotic concentrations to prevent infection
• B. Delivers high local antibiotic concentrations to prevent or treat infection; especially useful in revisions or high-risk patients
• C. Acts as a mechanical spacer without antibiotic action
• D. No role in infection prevention

Answer: (B)

Antibiotic-loaded bone cement serves as a local antibiotic carrier at the prosthesis interface, delivering high concentrations of antibiotic directly where infection risk is greatest while keeping systemic exposure relatively low. This local delivery is especially valuable for preventing or treating periprosthetic infection in situations with increased risk, such as revision arthroplasty or in patients with prior infection, compromised soft tissues, or other risk factors. In practice, it’s used to augment infection control during two-stage revisions with antibiotic spacers and as part of prophylaxis or targeted therapy, working alongside systemic antibiotics. It’s not intended to provide high systemic antibiotic levels, and the antibiotic release from the cement tends to peak early and then wane over time, so its use is tailored to the clinical scenario and must consider antibiotic compatibility with the cement and potential effects on cement strength.