Current Concepts of Local Antibiotic Delivery in Bone and Joint Infections-A Narrative Review of Techniques and Clinical Experiences.

Prophylactic measures and treatment strategies of implant-related bone and joint infections frequently involve the local delivery of high doses of antimicrobial drugs into the affected bone tissue or articular space in addition to the use of systemic antibiotics. Antibiotic-loaded biomaterials, such as Polymethyl Methacrylate (PMMA) cement, calcium sulfate, calcium phosphate, bioglass, and others, have proven to be clinically effective. However, they suffer from important limitations regarding elution and freedom of choice of admixable antimicrobial drugs. In order to overcome these shortcomings, the techniques of direct intraosseous or intra-articular injection/infusion of antibiotics via needles/cannulas or catheters are gaining popularity. Their attractiveness is based on the potential to achieve extremely high drug concentrations in situ, which can be maintained for as long as the catheters are left in place without increased risks of systemic toxicity. Although these methods are still in an experimental stage, reports on their clinical outcomes look promising. This articles summarizes the knowledge of when, how, and in which clinical settings the different modes and philosophies of local antibiotic delivery work best, with the aim to provide surgeons and infectious disease physicians guidance in clinical practice. This will help to optimize the use for the sake of the patients.