Local Delivery of Antibiotic and Antiseptic

Total knee arthroplasty (TKA) is considered one of the most cost-effective orthopedic surgical procedures with more than one million procedures performed every year. Periprosthetic joint infection (PJI) is a rare but devastating complication associated with extensive economic, physical, and psychological costs. Early PJI has been associated with preoperative bacterial infection of the patient, or intraoperative bacterial contamination from surgical team, operative tools, and instruments. Currently, the use of perioperative systemic antibiotics in TJA is the only consensus recommendation by international authorities. In order to reduce the incidence of PJI, multiple prevention strategies have been progressively introduced. Intraoperative irrigation with antiseptic solutions could be considered a potential tool in reducing the risk of early PJI after TKA by preventing the formation of bacterial biofilm. To date, there is no shared consensus regarding the usage of the best antiseptic solution in order to prevent and/or eradicate biofilm formation. The application of antimicrobial agents at the site of musculoskeletal infections has been widely documented, ranging from the direct intra-articular infusion of antibiotic after TKA to the intrawound placement of antibiotic powder to prevent infection in spinal surgery. Due to a lack of clarification regarding the long-term efficacy of locally administrated antibiotics, the combination of antibiotics with implantable materials has been progressively investigated in order to provide a predictable release profile. Different implant-coating alternatives have been developed to reduce the risk of early PJI. The goal is to create a local environment favorable to the host and hostile to the microorganisms in order to reduce the bacterial adhesion to the implant and the subsequent biofilm formation.