Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews
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
By Novriansyah R, Respati DRP, Sadjidah ZF and 5 others.
Abstract
Background
Local antibiotic delivery systems-including defensive antibacterial coating (DAC), calcium sulfate beads (CSBs), and antibiotic-loaded bone cement (BC)-have been developed to prevent and manage periprosthetic joint infection (PJI). However, their comparative effectiveness remains unclear.
Methods
A systematic search was conducted across PubMed, Cochrane, SpringerLink, ProQuest, and Scopus. Eligible studies involved adults undergoing total hip arthroplasty or total knee arthroplasty and evaluated DAC, CSB, or BC. Inclusion criteria encompassed randomized controlled trials, cohort studies, or matched case-control studies with control groups and relevant outcomes. Key endpoints included infection rate, C-reactive protein, Knee Society Score, Harris Hip Score, and length of hospital stay (LoS). Meta-analyses were done using RStudio with the meta, metafor, and netmeta packages. Effect estimates were presented as odds ratio or mean differences (MDs) with 95% confidence intervals. Evidence quality was assessed using the GRADE approach.