Recent advances in PMMA bone cement-loaded delivery systems for the treatment of open bone defect infections

INTRODUCTION: Postoperative fracture infection can cause serious limb deformity and dysfunction. Polymethylmethacrylate (PMMA) bone cement is widely used for treating open bone defect infections, yet its limitations necessitate a review of current strategies and future directions. AREAS COVERED: This review summarizes PMMA's history, biological properties, and drug-loaded applications in orthopedics, focusing on antibiotic combination therapy for fracture defects. Literature was sourced from PubMed and Web of Science, covering studies from the clinical introduction of PMMA to recent advances published up to 2025. EXPERT OPINION: PMMA bone cement remains a critical antibiotic delivery system. While modified composites and combination strategies show promise in improving release profiles and osteogenic activity, challenges such as non-degradability, optimal pore formation, and clinical translation of bioactive additives persist. Future research should prioritize developing fully biodegradable, highly osteogenic PMMA alternatives and establishing standardized protocols for antibiotic combination therapies. The ideal solution would balance mechanical strength, drug release kinetics, and complete resorption, potentially transforming infected bone defect management within five years.