Defensive antibacterial coating reduces periprosthetic joint infection risk with odds ratio of 0.14Antibacterial coating shows best results for preventing joint infection

BACKGROUND: Local antibiotic delivery systems-including defensive antibacterial coating (DAC), calcium sulfate beads (CSBs), and antibiotic-loaded bone cement (BC)-have been developed to prevent and manage periprosthetic joint infection (PJI). However, their comparative effectiveness remains unclear. METHODS: A systematic search was conducted across PubMed, Cochrane, SpringerLink, ProQuest, and Scopus. Eligible studies involved adults undergoing total hip arthroplasty or total knee arthroplasty and evaluated DAC, CSB, or BC. Inclusion criteria encompassed randomized controlled trials, cohort studies, or matched case-control studies with control groups and relevant outcomes. Key endpoints included infection rate, C-reactive protein, Knee Society Score, Harris Hip Score, and length of hospital stay (LoS). Meta-analyses were done using RStudio with the meta, metafor, and netmeta packages. Effect estimates were presented as odds ratio or mean differences (MDs) with 95% confidence intervals. Evidence quality was assessed using the GRADE approach. RESULTS: Seventeen studies involving 3672 patients were included. DAC showed the greatest reduction in PJI (odds ratio = 0.14; 95% confidence interval, 0.04 to 0.42; P < 0.001) and a modest improvement in Harris Hip Score (MD = 2.77; P < 0.01), whereas CSB and BC showed less consistent benefits. DAC was also associated with reduced length of hospital stay (MD = -11.29 days; P < 0.05). Meta-regression identified male proportion as a moderator of C-reactive protein and intervention type as a determinant of length of hospital stay. CONCLUSION: DAC demonstrates superior efficacy among local antibiotic carriers in reducing PJI and enhancing postoperative outcomes in total hip arthroplasty and total knee arthroplasty.