ALLERGIC REACTION TO ANTIBIOTIC-LOADED PMMA BONE CEMENT AND CONSTITUENTS IN KNEE ARTHROPLASTY

Antibiotic-loaded polymethylmethacrylate (PMMA) bone cement is a cornerstone in knee arthroplasty, providing mechanical stability and infection prophylaxis. However, hypersensitivity reactions to its constituents, including methylmethacrylate monomer, benzoyl peroxide, and incorporated antibiotics like gentamicin, are an emerging concern. Gentamicin, a commonly used additive, has been implicated in allergic reactions, with studies reporting positive patch test results in up to 2–5% of tested patients. Such reactions can present as dermatitis, chronic pain, implant loosening, or systemic symptoms, complicating postoperative recovery. Clinical data indicate that revision surgery without gentamicin-containing cement often results in significant symptom resolution and favorable outcomes. Diagnosis of hypersensitivity remains challenging and requires a multidisciplinary approach, including detailed patient history, patch testing, and occasionally in vitro immune response assays like lymphocyte transformation tests. To minimize risks, preoperative screening for antibiotic hypersensitivity in cases of reasonable suspicion of an allergy and the use of alternative cement formulations or antibiotics are good possibilities for a better outcome. Advances in materials with reduced allergenic potential and personalized therapeutic strategies promise improved patient care. In this work, we want to show the frequencies and pathways of a possible bone cement allergy and present ways in which better patient care and treatment can be achieved after knee arthroplasty.