top of page
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

Screen Shot 2018-08-12 at 1.24.09 AM.png
Screen Shot 2018-08-12 at 1.24.02 AM.png
Screen Shot 2018-08-12 at 1.23.57 AM.png
Screen Shot 2018-08-12 at 1.23.52 AM.png
open access

Published: 17 February 2024

Systematic Review on the Current Situation and Development of Local Antimicrobial Agents in Revision Arthroplasty for Periprosthetic Joint Infection (PJI)

Mohamed Abdullahi Jama, Li Cao, Yichen Li, B Ji

Xinjiang Medical University, China

journal of social and political sciences
pdf download

Download Full-Text Pdf



Pages: 59-71

Keywords: Review, Local Antimicrobial Agents, Revision Arthroplasty, Periprosthetic Joint Infection


Total joint arthroplasty is a common surgery to treat degenerative joint disease, and it significantly improves the lives of people suffering from conditions such as osteoarthritis. Moreover, it is very essential to know that the fact that the level of joint replacement surgery is discouraged by complications, therefore making the periprosthetic infection (PJI) to become a critical issue. As such PJI is full of significant negative results in a current pain, implant failure, and also as a systemic infection. Basically, the complex origin of PJI is usually involved in the formation of biofilms (protective communities of bacteria) which become resistant to the standard treatments. This capability to resist is able to highlight the urgency to look more into new strategies so as to particularly disrupt and to be able to prevent biofilm formation. In addition to that Topical antimicrobials that generally range from intraarticular antibiotic infusions and antibiotic-filled spacers, have therefore become the focus of this effort. In addition to this, the drugs are able to target the infection site directly, that probably leads to the minimization of systemic exposure and therefore increasing effectiveness of the treatment. Therefore, the knowledge of this challenges, this specific systematic review tends to aim so as to assess the current state and as well as advancements in local antimicrobial agents for the management of PJI. Moreover, by involving mechanisms, consideration of safety, in addition to its effectiveness, the review is able to give out insights that may shape more effective clinical approaches so as to fight Periprosthetic Joint Infection.


  1. Anagnostakos, K., & Schmitt, C. M. (2018). Antibiotic-loaded bone cement spacers in two-stage revision of infected total knee arthroplasty: what is the evidence? The Journal of the American Academy of Orthopaedic Surgeons, 26(7), e147-e157.

  2. Anagnostakos, K., Kelm, J., Regitz, T., & Schmitt, E. (2010). Jungbluth P. In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic‐impregnated polymethylmethacrylate hip spacers. The Journal of Arthroplasty, 25(6), 1016-1021.

  3. Anagnostakos, K., Fürst, O., & Kelm, J. (2006). Antibiotic-impregnated PMMA hip spacers: Current status. Acta Orthopaedica, 77(4), 628-637.

  4. Artz, N., Dixon, S., Patel, S., & Smith, R. (2015). The management of infected total hip arthroplasty. The Bone & Joint Journal, 97(10), 1349-1359.

  5. Atkin, B., Dupley, L., Chakravorty, P., Zafar, K., & Boden, R. (2022). Approach to patients with a potential prosthetic joint infection. BMJ, e069502.

  6. Baddour, L. M., & Chen, A. F. (2022). Prosthetic joint infection: Treatment. UpToDate. Retrieved from

  7. Bayramov, D. F., & Neff, J. A. (2017). Beyond conventional antibiotics—New directions for combination products to combat biofilm. Advanced drug delivery reviews, 112, 48-60.

  8. Chahal, J., Van Thiel, G. S., Mather III, R. C., Lee, S., Song, S. H., Davis, A. M., ... & Nho, S. J. (2015). The patient acceptable symptomatic state for the modified Harris Hip Score and Hip Outcome Score among patients undergoing surgical treatment for femoroacetabular impingement. The American Journal of Sports Medicine, 43(8), 1844-1849.

  9. Chakrapani, G., Zare, M., & Ramakrishna, S. (2022). Intelligent hydrogels and their biomedical applications. Materials Advances, 3(21), 7757-7772.

  10. Cyphert, E. L. (2020). Towards the creation of polymer composites which can be refilled with antibiotics after implantation for infection treatment (Doctoral dissertation, Case Western Reserve University).

  11. Day, C. W., Costi, K., Pannach, S., Atkins, G. J., Hofstaetter, J. G., Callary, S. A., Nelson, R., Howie, D. W., & Solomon, L. B. (2021). Long-term outcomes of staged revision surgery for chronic Periprosthetic joint infection of total hip arthroplasty. Journal of Clinical Medicine, 11(1), 122.

  12. Elliott, R. E., Morsi, A., Kalhorn, S. P., Marcus, J., Sellin, J., Kang, M., ... & Doyle, W. K. (2011). Vagus nerve stimulation in 436 consecutive patients with treatment-resistant epilepsy: long-term outcomes and predictors of response. Epilepsy & behavior, 20(1), 57-63.

  13. Engin, A. B., & Engin, A. (2019). Nanoantibiotics: A novel rational approach to antibiotic resistant infections. Current Drug Metabolism, 20(9), 720-741.

  14. Evans, D., Barcons, A. M., Basit, R. H., Adams, C., & Chari, D. M. (2023). Evaluating the feasibility of hydrogel-based neural cell sprays. Journal of Functional Biomaterials, 14(10), 527.

  15. Foster, A. L. (2023). Improving the management of fracture-related infection through local antibiotic therapy (Doctoral dissertation, Queensland University of Technology).

  16. Fu, J., Xiang, Y., Ni, M., Chen, J., Li, X., Yu, B., Liu, K., Zhou, Y., & Hao, L. (2020). The use of augmented antibiotic-loaded cement spacer in periprosthetic joint infection patients with acetabular bone defect. Journal of Orthopaedic Surgery and Research, 15(1).

  17. Getzlaf, M. A., Lewallen, E. A., Kremers, H. M., Jones, D. L., Bonin, C. A., Dudakovic, A., ... & Van Wijnen, A. J. (2016). Multi‐disciplinary antimicrobial strategies for improving orthopaedic implants to prevent prosthetic joint infections in hip and knee. Journal of orthopaedic research, 34(2), 177-186.

  18. Gonçalves, J. O., Esquerdo, V. M., Sant’Anna Cadaval, T. R., & de Almeida Pinto, L. A. (2019). Chitosan-based hydrogels. Sustainable Agriculture Reviews 36: Chitin and Chitosan: Applications in Food, Agriculture, Pharmacy, Medicine and Wastewater Treatment, 147-173.

  19. Grand, J. H., Caspar, S., & MacDonald, S. W. (2011). Clinical features and multidisciplinary approaches to dementia care. Journal of multidisciplinary healthcare, 125-147.

  20. Hall-Stoodley, L., Costerton, J. W., & Stoodley, P. (2004). Bacterial biofilms: from the natural environment to infectious diseases. Nature Reviews Microbiology, 2(2), 95-108.

  21. Horlocker, T. T., Birnbach, D. S., Connis, R. T., Nickinovich, D. G., Palmer, C. M., Pollock, J. E., ... & Wu, C. L. (2011). Practice advisory for the prevention, diagnosis, and management of infectious complications associated with neuraxial techniques: a report by the American Society of Anesthesiologists Task Force on infectious complications associated with neuraxial techniques. Obstetric Anesthesia Digest, 31(2), 85.

  22. Iarikov, D., Demian, H., Rubin, D., Alexander, J., & Nambiar, S. (2012). Choice and doses of antibacterial agents for cement spacers in treatment of prosthetic joint infections: Review of published studies. Clinical Infectious Diseases, 55(11), 1474-1480.

  23. Ji, B., Li, G., Zhang, X., Xu, B., Wang, Y., Chen, Y., & Cao, L. (2022). Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection: a mean seven years' follow-up. The Bone & Joint Journal, 104(7), 867-874.

  24. Ji, B., Wahafu, T., Li, G., Zhang, X., Wang, Y., Momin, M., & Cao, L. (2019). Single-stage treatment of chronically infected total hip arthroplasty with cementless reconstruction: results in 126 patients with broad inclusion criteria. The Bone & Joint Journal, 101(4), 396-402.

  25. Kalelkar, P. P., Riddick, M., & García, A. J. (2022). Biomaterial-based antimicrobial therapies for the treatment of bacterial infections. Nature Reviews Materials, 7(1), 39-54.

  26. Karczewski, D., Ren, Y., Andronic, O., Akgün, D., Perka, C., Müller, M., & Kienzle, A. (2021). Candida periprosthetic joint infections — risk factors and outcome between albicans and non-albicans strains. International Orthopaedics, 46(3), 449-456.

  27. Koo, H., Allan, R. N., Howlin, R. P., Stoodley, P., & Hall-Stoodley, L. (2017). Targeting microbial biofilms: current and prospective therapeutic strategies. Nature Reviews Microbiology, 15(12), 740-755.

  28. Kozlowski, H. N. (2022). Strategies for Moving Multi-Target Nucleic Acid Assays Towards Clinical Use (Doctoral dissertation, University of Toronto (Canada)).

  29. Le Vavasseur, B., & Zeller, V. (2022). Antibiotic therapy for prosthetic joint infections: An overview. Antibiotics, 11(4), 486.

  30. Le, H., Karakasyan, C., Jouenne, T., Le Cerf, D., & Dé, E. (2021). Application of polymeric nanocarriers for enhancing the bioavailability of antibiotics at the target site and overcoming antimicrobial resistance. Applied Sciences, 11(22), 10695.

  31. Lei, L., Bai, Y., Qin, X., Liu, J., Huang, W., & Lv, Q. (2022). Current understanding of Hydrogel for drug release and tissue engineering. Gels, 8(5), 301.

  32. Li, Y., Zhang, X., Guo, X., Wulamu, W., Yushan, N., Ji, B., & Cao, L. (2022). Effective treatment of single-stage revision using intra-articular antibiotic infusion for polymicrobial periprosthetic joint infection. The Journal of Arthroplasty, 37(1), 156-161.

  33. Li, P., Hu, J., Wang, J., Zhang, J., Wang, L., & Zhang, C. (2023). The role of Hydrogel in cardiac repair and regeneration for myocardial infarction: Recent advances and future perspectives. Bioengineering, 10(2), 165.

  34. Li, Z., Xu, C., & Chen, J. (2023). Articulating spacers: What are available and how to utilize them? Arthroplasty, 5(1).

  35. Lunz, A., Knappe, K., Omlor, G. W., Schonhoff, M., Renkawitz, T., & Jaeger, S. (2022). Mechanical strength of antibiotic-loaded PMMA spacers in two-stage revision surgery. BMC Musculoskeletal Disorders, 23(1).

  36. Matthias, J., Bostrom, M. P., & Lane, J. M. (2021). A comparison of risks and benefits regarding hip arthroplasty fixation. JAAOS Global Research & Reviews, 5(11), e21.

  37. McLaren, A. C., & McLaren, S. G. (2016). Intra-articular antibiotic infusion for the treatment of patients with septic arthritis of the native shoulder joint. The Journal of Bone and Joint Surgery. American Volume, 98(22), 1915-1923.

  38. Mian, H. M., Lyons, J. G., Perrin, J., Froehle, A. W., & Krishnamurthy, A. B. (2022). A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. Arthroplasty, 4(1).

  39. Mu, W., Ji, B., & Cao, L. (2023). Single-stage revision for chronic periprosthetic joint infection after knee and hip arthroplasties: Indications and treatments. Arthroplasty, 5(1).

  40. Mustafa, Y. F. (2023). Emerging trends and future opportunities for coumarin-heterocycle conjugates as antibacterial agents. Results in Chemistry, 101151.

  41. Neuberger, J. M., Bechstein, W. O., Kuypers, D. R., Burra, P., Citterio, F., De Geest, S., ... & Van Gelder, T. (2017). Practical recommendations for long-term management of modifiable risks in kidney and liver transplant recipients: a guidance report and clinical checklist by the consensus on managing modifiable risk in transplantation (COMMIT) group. Transplantation, 101(4S), S1-S56.

  42. Okafor, C. E., Nghiem, S., & Byrnes, J. (2023). One-stage revision versus debridement, antibiotics, and implant retention (DAIR) for acute prosthetic knee infection: an exploratory cohort study. Archives of Orthopaedic and Trauma Surgery, 1-6.

  43. Osmon, D. R., Berbari, E. F., Berendt, A. R., Lew, D., Zimmerli, W., Steckelberg, J. M., Rao, N., Hanssen, A., & Wilson, W. R. (2013). Diagnosis and management of prosthetic joint infection: Clinical practice guidelines by the infectious diseases society of Americaa. Clinical Infectious Diseases, 56(1), e1-e25.

  44. Parvizi, J., & Tarity, T. D. (2012). Diagnosis of periprosthetic joint infection. The Journal of Arthroplasty, 27(8 Suppl), 12-16.

  45. Parvizi, J., Tan, T. L., Goswami, K., Higuera, C., Della Valle, C., Chen, A. F., & Shohat, N. (2018). The 2018 definition of Periprosthetic hip and knee infection: An evidence-based and validated criteria. The Journal of Arthroplasty, 33(5), 1309-1314.e2.

  46. Parvizi, J., Zmistowski, B., Berbari, E. F., Bauer, T. W., Springer, B. D., Della Valle, C. J., Garvin, K. L., Mont, M. A., Wongworawat, M. D., & Zalavras, C. G. (2011). New definition for Periprosthetic joint infection: From the Workgroup of the musculoskeletal infection society. Clinical Orthopaedics & Related Research, 469(11), 2992-2994.

  47. Piggott, R. P., Chan, D. S., & Young, S. W. (2019). Intra-articular antibiotics in hip and knee arthroplasty: a narrative review. Journal of Orthopaedic Surgery, 27(3), 2309499019862222.

  48. Rabin N., Zheng Y., Opoku-Temeng C., Du Y., Bonsu E., Sintim H.O. Biofilm formation mechanisms and targets for developing antibiofilm agents. Future Med. Chem. 2015; 7:493–512. doi: 10.4155/fmc.15.6.

  49. Rathbone C.R., Cross J.D., Brown K.V., Murray C.K., Wenke J.C. Effect of various concentrations of antibiotics on osteogenic cell viability and activity. J. Orthop. Res. 2011;29:1070–1074. doi: 10.1002/jor.21343

  50. Ricciardi, B. F., Muthukrishnan, G., Masters, E. A., Kaplan, N., Daiss, J. L., & Schwarz, E. M. (2020). New developments and future challenges in prevention, diagnosis, and treatment of prosthetic joint infection. Journal of Orthopaedic Research®, 38(7), 1423-1435.

  51. Rodríguez-Merchán, E. C., Davidson, D. J., & Liddle, A. D. (2021). Recent strategies to combat infections from biofilm-forming bacteria on orthopaedic implants. International Journal of Molecular Sciences, 22(19), 10243.

  52. Sabater-Martos, M., Verdejo, M. A., Morata, L., Muñoz-Mahamud, E., Guerra-Farfan, E., Martinez-Pastor, J. C., & Soriano, A. (2023). Antimicrobials in polymethylmethacrylate: From prevention to prosthetic joint infection treatment: basic principles and risk of resistance. Arthroplasty, 5(1).

  53. Samuel, J. R., & Gould, F. K. (2009). Prosthetic joint infections: Single versus combination therapy. Journal of Antimicrobial Chemotherapy, 65(1), 18-23.

  54. Shoji, M., Sloan, M., Premkumar, A., Sheth, N., Phillips, J., Crane, T., ... & Auguściak-Duma, A. (2020). Biofilms in periprosthetic joint infections: a review of diagnostic modalities, current treatments, and future directions. The Journal of Knee Surgery, 33(02), 119-131.

  55. Sires, J. D., Pham, K., Daniel, S., Inglis, M., & Wilson, C. J. (2022). A Multi-Disciplinary Approach for the Management of Prosthetic Joint Infections: An Australian Perspective. Malaysian Orthopaedic Journal, 16(2), 41.

  56. Spellberg, B., Bartlett, J., Wunderink, R., & Gilbert, D. N. (2015). Novel approaches are needed to develop tomorrow’s antibacterial therapies. American journal of respiratory and critical care medicine, 191(2), 135-140.

  57. Steadman, W., Chapman, P. R., Schuetz, M., Schmutz, B., Trampuz, A., & Tetsworth, K. (2023). Local antibiotic delivery options in prosthetic joint infection. Antibiotics, 12(4), 752.

  58. Szyk, P., Czarczynska-Goslinska, B., Mlynarczyk, D. T., Ślusarska, B., Kocki, T., Ziegler-Borowska, M., & Goslinski, T. (2023). Polymer-Based Nanoparticles as Drug Delivery Systems for Purines of Established Importance in Medicine. Nanomaterials, 13(19), 2647.

  59. Taha, M., Abdelbary, H., Ross, F. P., & Carli, A. V. (2018). New innovations in the treatment of PJI and biofilms—clinical and preclinical topics. Current reviews in musculoskeletal medicine, 11, 380-388.

  60. ter Boo, G. J. A., Grijpma, D. W., Moriarty, T. F., Richards, R. G., & Eglin, D. (2015). Antimicrobial delivery systems for local infection prophylaxis in orthopedic-and trauma surgery. Biomaterials, 52, 113-125.

  61. Tzeng, A., Tzeng, T. H., Vasdev, S., Korth, K., Healey, T., Parvizi, J., & Saleh, K. J. (2015). Treating periprosthetic joint infections as biofilms: key diagnosis and management strategies. Diagnostic microbiology and infectious disease, 81(3), 192-200.

  62. Van Vugt, T. A., Arts, J. J., & Geurts, J. A. (2019). Antibiotic-loaded Polymethylmethacrylate beads and spacers in treatment of orthopedic infections and the role of Biofilm formation. Frontiers in Microbiology, 10.

  63. Waheed, H., Mehmood, C. T., Yang, Y., Tan, W., Fu, S., & Xiao, Y. (2022). Dynamics of biofilms on different polymeric membranes–A comparative study using five physiologically and genetically distinct bacteria. Journal of Membrane Science, 642, 120000.

  64. Weese, J. S., Blondeau, J. M., Boothe, D., Breitschwerdt, E. B., Guardabassi, L., Hillier, A., ... & Sykes, J. E. (2011). Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the international society for companion animal infectious diseases. Veterinary medicine international, 2011.

  65. Wignadasan, W., Ibrahim, M., & Haddad, F. S. (2023). One-or two-stage reimplantation for infected total knee prosthesis?. Orthopaedics & Traumatology: Surgery & Research, 109(1), 103453.

  66. Wouthuyzen-Bakker, M., Löwik, C. A., Knobben, B. A., Zijlstra, W. P., Ploegmakers, J. J., Mithoe, G., Al Moujahid, A., Kampinga, G. A., & Jutte, P. C. (2018). Use of gentamicin-impregnated beads or sponges in the treatment of early acute periprosthetic joint infection: A propensity score analysis. Journal of Antimicrobial Chemotherapy.

  67. Xie, H., Liu, Y., An, H., Yi, J., Li, C., Wang, X., & Chai, W. (2022). Recent advances in prevention, detection, and treatment of prosthetic joint infections of bioactive materials. Frontiers in Bioengineering and Biotechnology, 10, 1053399.

  68. Xiong, M. H., Bao, Y., Yang, X. Z., Zhu, Y. H., & Wang, J. (2014). Delivery of antibiotics with polymeric particles. Advanced drug delivery reviews, 78, 63-76.

  69. Zheng, H., Zhou, Y., Zheng, Y., & Liu, G. (2023). Advances in hydrogels for the treatment of periodontitis. Journal of Materials Chemistry B, 11(31), 7321-7333.

  70. Zimmerli, W., & Sendi, P. (2010). Pathogenesis of implant-associated infection: the role of the host. Seminars in Immunopathology, 33(3), 295-306.

bottom of page