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
- Journal
- Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews (Q1)
- Published
- 14 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Robin Novriansyah, Danendra Rakha Putra Respati, Zahra Fathin Sadjidah, Davendra Putra Aryasatya, Maritza Bintang Rismadha, Fitri Mutmainnah, et al.
- PMID
- 42878557
- DOI
- e25.00304
Why clinicians should know about it
- Picked for Orthopedics and Sports Medicine (paper of the day, 16 October 2026): Systematic review, local antibiotics for PJI reduction
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. RESULTS: Seventeen studies involving 3672 patients were included. DAC showed the greatest reduction in PJI (odds ratio = 0.14; 95% confidence interval, 0.04 to 0.42; P < 0.001) and a modest improvement in Harris Hip Score (MD = 2.77; P < 0.01), whereas CSB and BC showed less consistent benefits. DAC was also associated with reduced length of hospital stay (MD = -11.29 days; P < 0.05). Meta-regression identified male proportion as a moderator of C-reactive protein and intervention type as a determinant of length of hospital stay. CONCLUSION: DAC demonstrates superior efficacy among local antibiotic carriers in reducing PJI and enhancing postoperative outcomes in total hip arthroplasty and total knee arthroplasty.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.