Antibiotic-Loaded Hydrogel, Calcium Bead, and Cement in Periprosthetic Joint Infection Following Hip-Knee Arthroplasty: A Systematic Review and Meta-Analysis of Commercially Available Products.
Robin Novriansyah, Danendra Rakha Putra Respati, Zahra Fathin Sadjidah et al.
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In 30 seconds
This systematic review and meta-analysis compared defensive antibacterial coating (DAC), calcium sulfate beads, and antibiotic-loaded bone cement for preventing or managing periprosthetic joint infection after total hip or knee arthroplasty. It included 17 studies involving 3672 patients. DAC was associated with lower PJI odds than control (odds ratio = 0.14; 95% confidence interval, 0.04 to 0.42; P < 0.001), a modestly higher Harris Hip Score, and shorter hospital stay. Benefits with calcium sulfate beads and bone cement were less consistent. The authors concluded that DAC had the strongest overall results among the products assessed.
Key findings
- DAC was associated with reduced PJI odds (odds ratio = 0.14; 95% confidence interval, 0.04 to 0.42; P < 0.001).
- DAC was associated with a higher Harris Hip Score (MD = 2.77; P < 0.01).
- DAC was associated with shorter hospital stay (MD = -11.29 days; P < 0.05).
- Benefits from calcium sulfate beads and antibiotic-loaded bone cement were less consistent.
Why it matters
Local antibiotic carriers are used to prevent or manage infection around hip and knee prostheses, but their comparative effectiveness is uncertain. These pooled findings suggest that outcomes may differ by product, with DAC showing the strongest association with reduced infection and some postoperative benefits. The results help frame comparative evidence, while the included study designs and evidence quality should inform interpretation.
What to keep in mind
The review combined randomized trials and observational studies, and the abstract does not report the GRADE ratings or study-level heterogeneity, limiting assessment of certainty and comparability.