- Design
- Systematic review and meta-analysis of 17 RCTs and observational studies
- Population
- 3,672 adults undergoing hip or knee arthroplasty
- Primary outcome
- Periprosthetic joint infection
- Effect
- Hydrogel coating OR 0.14 (95% CI 0.04 to 0.42)
A systematic review and meta-analysis compared three local antibiotic carriers used in hip and knee arthroplasty: an antibiotic-loaded hydrogel coating applied to the implant, calcium sulfate beads and antibiotic-loaded bone cement. It included 17 randomised and observational studies with 3,672 patients. Published in JAAOS Global Research and Reviews on 14 October 2026.
The hydrogel coating was associated with the largest reduction in periprosthetic joint infection (OR 0.14, 95% CI 0.04 to 0.42) and a modest gain in Harris Hip Score. Results for beads and cement were less consistent.
The pooled studies differ in setting, from primary to revision and high-risk cases, and many are non-randomised, so the comparison between carriers is indirect. A reported difference in length of stay of about 11 days is implausibly large for primary arthroplasty and probably reflects case mix. The finding is a reason to watch for randomised data, not to change routine practice on its own.
- Consider local antibiotic carriers mainly in high-risk or revision arthroplasty
- Treat comparisons between carriers as provisional until randomised trials report
- Check local availability and cost of hydrogel coatings before planning their use
- Keep established infection-prevention steps as the foundation
Why it matters
It is the first pooled comparison across the main local antibiotic carriers surgeons are choosing between.
Don't overread it
Mostly observational, indirect comparisons; a very wide interval and implausible length-of-stay estimate suggest case-mix bias.
The statistics, in plain English
An odds ratio of 0.14 implies a large reduction in infection, but the interval from 0.04 to 0.42 is wide, reflecting few events. Large effects from small, non-randomised studies often shrink in later trials.
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