- Design
- Systematic review and meta-analysis (RCTs, cohort and case-control studies)
- Population
- 3,672 adults undergoing hip or knee arthroplasty
- Primary outcome
- Periprosthetic joint infection
- Effect
- Hydrogel coating OR 0.14 (0.04–0.42)
This meta-analysis pooled 17 studies (3,672 patients) of hip and knee arthroplasty that used one of three local antibiotic delivery systems — an antibiotic-loaded hydrogel coating applied to the implant, calcium sulfate beads, or antibiotic-loaded bone cement — compared with controls.
The hydrogel coating was associated with the largest reduction in periprosthetic joint infection (OR 0.14, 95% CI 0.04–0.42), while beads and cement showed less consistent benefit. A reported 11-day shorter hospital stay with the coating is implausibly large for routine arthroplasty and should be treated with caution.
Most included studies were observational and mixed primary and revision surgery, so these comparisons are indirect. The findings support interest in local antibiotic delivery for high-risk and revision cases, not a change in routine primary arthroplasty.
- Consider local antibiotic delivery mainly for revision or high-risk primary arthroplasty.
- Comparisons between carriers here are indirect and largely observational.
- Weigh cost and availability, which limit hydrogel coatings in many Indian centres.
- Local antibiotics do not replace timely systemic prophylaxis and skin preparation.
Why it matters
Surgeons are increasingly offered several local antibiotic products, and head-to-head comparisons are scarce.
Don't overread it
Mostly observational, mixed populations; the ranking is not head-to-head trial evidence.
The statistics, in plain English
An odds ratio of 0.14 suggests a large reduction, but the wide interval (0.04–0.42) and observational designs mean the true effect could be much smaller.
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