CORR Insights®: How Long Does Antimycobacterial Antibiotic-loaded Bone Cement Have In Vitro Activity for Musculoskeletal Tuberculosis?

The mainstay of treatment of osteomyelitis is based on surgical debridement and systemic administration of antibiotics for prolonged time. However, intravenous therapy may not ensure adequate local concentration of antibiotics in necrotic bone tissue to eradicate biofilm related infections without general complications and toxicity. Over 30 years ago, Bulchoz and Engelbrecht reported that penicillin, erythromycin, and gentamicin introduced into the cement used to stabilize the hip, spread into the surrounding tissues for months bringing thus a prolonged local concentration of antibiotic. In 1979, Klemm extended this concept to the treatment of chronic osteomyelitis introducing gentamicin in cement beads. After these findings, antibiotic-loaded bone cements (ALBC) was increasingly used for the treatment of osteomyelitis, particularly for periprosthetic infections. Nevertheless, the real effectiveness of ALBC is currently under debate and there are still many doubts on several aspects: the method of preparation, the choice of the antibiotic, the effective release and diffusion of the antibiotic in the surrounding tissues, and the mechanical properties of the cement.