Current and emerging antibacterial strategies for periprosthetic joint infection: An overview
Abstract
Periprosthetic Joint Infection (PJI) represents one of the most serious complications following joint arthroplasty, with impactful consequences in the clinic and economy. Characterized by biofilm formation on implant surfaces, PJI poses significant therapeutic challenges due to the limited efficacy of systemic antibiotics and the increasing prevalence of multidrug-resistant bacteria. This review paper presents a comprehensive analysis of current and emerging antibacterial strategies designed to mitigate the risk of infection in total joint arthroplasty (TJA). It spans two decades of literature, from 2003 to 2025, with a particular focus on local antibiotic delivery systems, including bone cements, spacers, beads, and novel biomaterial carriers evaluated across in vitro assays, in vivo animal models, and in vivo clinical trials. A systematic search of the Web of Science Core Collection (1 January 2003-31 December 2025; last search: October 2025) identified 300 records; after de-duplication and screening, 138 studies met inclusion criteria (14 in vitro, 25 animal, 99 clinical). Evidence was synthesized using a clinical-pathway framework comparing PMMA-based strategies with resorbable depots, hydrogels, coatings/nanomaterials, and emerging antibiofilm agents. The performance of PolyMethylMethAcrylate (PMMA)-based Antibiotic-Loaded Bone Cements (ALBCs) is critically assessed, highlighting key limitations such as inconsistent drug release, suboptimal biofilm penetration, and…
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Evidence Hub reads this as a review, done in animal, not in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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