OBJECTIVES: Total joint replacement is one of the most performed elective orthopedic surgery, with major concern being implant associated infections. Significant percentage of knee arthroplasty patients undergo revision surgeries to treat infections that colonize the surface of the joint. Nearly 2% of total knee/hip arthroplasties results in periprosthetic joint infection (PJI) that affects patients’ quality of life. The purpose of this systematic literature review (SLR) was to examine the safety and effectiveness of currently available surface coated implants that aid in reducing or controlling post-operative PJI in knee arthroplasty patients.

METHODS: We searched EMBASE, PubMed, and Cochrane Library databases. The searches were done for time period, 01 January 2011 to 08 June 2021. For additional publications, bibliographic searches of included studies and web searches were conducted. Two reviewers independently screened the titles and abstracts to identify relevant studies of clinical outcomes and PJI complications after the application of antimicrobial coating. A critical appraisal was performed for the included studies using the Newcastle-Ottawa scale.

RESULTS: A comprehensive review following PRISMA guidelines was conducted. Out of 964 studies, eight studies were included and were of good quality. Most of the studies had patients aged ≥50 years. Five studies involved silver coated implants, while other three studied iodine, ceramic and calcium-based bone substitute coated implants, respectively. One of the studies for silver implants reported significant results, reduction in PJI incidence compared to titanium implants (5.9% vs. 17.6%; p= 0.062) and less aggressive treatment for infections was observed. Another study with iodine implants, showed no signs of infections and systemic adverse events at the end of 30 months follow-up. Other studies with ceramic and calcium implants reported non-significant reduction in PJI.

CONCLUSIONS: Findings from this SLR suggest that antimicrobial coated implants, especially silver and iodine coated, are effective in preventing and controlling PJI in patients undergoing knee arthroplasties.