OBJECTIVES: Total joint replacement is one of the most performed elective orthopedic surgery, with major concern being implant associated infections. Significant percentage of 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 modified antimicrobial 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 limited for January 2011 to December 2021. Grey literature search was also 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. Antibiotic laden cement spacers and coatings applied manually on implants such as DAC hydrogels were excluded. 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 1172 screened studies, eight were included, the quality of the included studies was good. Five involved patients with silver coated implants, while three with iodine, ceramic coated implants and calcium-based bone substitute respectively. One of the studies for silver implants reported significant reduction in PJI incidence compared to titanium implants (5.9% vs. 17.6%; p= 0.062) and less aggressive treatment for infections. 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 surface modified antimicrobial implants, especially silver and iodine coated, are effective in preventing and controlling PJI in patients undergoing knee arthroplasties.