{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:25:46Z","timestamp":1787239546241,"version":"build-2736575974"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004889","name":"Fondation du CHU de Qu\u00e9bec","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004889","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Royal National Orthopaedic Hospital NHS Trust"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Antimicrobial-loaded PMMA bone cement has been used since the 1970s as both a fixation material and a local antimicrobial reservoir. Its clinical roles differ between prophylaxis in primary arthroplasty and treatment of established infection, particularly during revision surgery and through the use of temporary spacers. Commercially manufactured products offer more predictable handling, but bespoke admixing may be considered when resistant or unusual organisms are encountered. This Viewpoint argues that such practice requires clearer governance. Cement formulation, antimicrobial choice, dose and mixing technique influence elution, bioactivity, mechanical strength and toxicity. Local delivery may support antimicrobial stewardship, but prolonged low-level elution could theoretically select for resistance if poorly planned. We propose a cautious, evidence-informed framework to support multidisciplinary decision-making and the development of PMMA-specific antimicrobial guidance.<\/jats:p>","DOI":"10.1093\/jac\/dkag261","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T11:46:14Z","timestamp":1784202374000},"source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial-loaded PMMA bone cement: time for good practice recommendations"],"prefix":"10.1093","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0576-9797","authenticated-orcid":false,"given":"Tariq","family":"Azamgarhi","sequence":"first","affiliation":[{"name":"Pharmacy Department, Royal National Orthopaedic Hospital NHS Trust , Stanmore ,","place":["UK"]},{"name":"Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust , Stanmore ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herbert","family":"Gbejuade","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Southmead Hospital , Southmead Road, Westbury on Trym, Bristol BS10 5NB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9328-2398","authenticated-orcid":false,"given":"Ryan A","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Faculty of Health and Life Sciences, Leicester School of Pharmacy, De Montfort University , Hawthorn Building, The Newarke, Leicester LE2 7BY ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Warren","sequence":"additional","affiliation":[{"name":"Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust , Stanmore ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth S R","family":"Darley","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Southmead Hospital , Southmead Road, Westbury-on-Trym, Bristol BS10 5NB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0625-3535","authenticated-orcid":false,"given":"Mark","family":"Gilchrist","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Imperial College Healthcare NHS Trust, Charing Cross Hospital , Fulham Palace Road, London W6 8RF ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erden","family":"Ali","sequence":"additional","affiliation":[{"name":"Joint Reconstruction Unit, Royal National Orthopaedic Hospital NHS Trust , Stanmore ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e9lix\u2013Antoine","family":"Garneau\u2013Picard","sequence":"additional","affiliation":[{"name":"Bone Infection Unit, Royal National Orthopaedic Hospital NHS Trust , Stanmore ,","place":["UK"]},{"name":"Division of Infectious Diseases and Medical Microbiology, CHU de Qu\u00e9bec\u2013Universit\u00e9 Laval, Qu\u00e9bec, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason C J","family":"Webb","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Southmead Hospital , Southmead Road, Westbury on Trym, Bristol BS10 5NB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"2026082010383554400_dkag261-B1","author":"National Joint Registry"},{"key":"2026082010383554400_dkag261-B2","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1007\/s11999-009-0945-0","article-title":"The epidemiology of revision total knee arthroplasty in the United States","volume":"468","author":"Bozic","year":"2010","journal-title":"Clin Orthop Relat 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