Antibiotic-Loaded Bone Cement Significantly Improves Diabetic Foot Ulcer Outcomes: Systematic Review and Meta-Analysis
Summary: A systematic review and meta-analysis published in Frontiers in Cellular and Infection Microbiology (March 2026) evaluated antibiotic-loaded bone cement (ALBC) — a polymethylmethacrylate (PMMA)-based sustained-release drug delivery system — for managing diabetic foot ulcers (DFUs). Conducted by Xin Li and Zunhong Liang at Hainan Medical University, China, this is the most comprehensive synthesis to date, incorporating 22 randomized controlled trials (RCTs) and 1,295 patients. ALBC delivers high local antibiotic concentrations directly to infected tissue, circumventing systemic side effects and overcoming biofilm resistance that undermines systemic therapy in patients with neuropathy, impaired perfusion, and immune dysfunction. Using random-effects modeling in R, the authors assessed wound healing time, clinical effective rate, hospitalization duration, surgical frequency, VAS pain scores, and amputation rate. ALBC significantly shortened wound healing time by a mean of 7.10 days, improved clinical effective rate more than fourfold (OR = 4.05), reduced hospital stay by 8.56 days, decreased surgical frequency, lowered pain scores (SMD = −1.29), and reduced amputation risk by 81% (OR = 0.19) — with zero heterogeneity in the amputation outcome. Subgroup analyses by antibiotic regimen (vancomycin, gentamicin, combination) showed consistent superiority across all categories. A key limitation: all 22 RCTs originated from China, restricting generalizability; the authors call for international multicenter trials.
Key Highlights:
- 22 RCTs, 1,295 patients: ALBC shortened wound healing by 7.10 days and improved clinical effective rate fourfold (OR = 4.05) vs. standard care
- Amputation risk reduced 81% (OR = 0.19; I² = 0%) — the most consistent finding across all included studies
- Hospital stay shortened by 8.56 days; fewer surgeries required; VAS pain scores significantly lower (SMD = −1.29)
- Efficacy consistent regardless of antibiotic regimen — vancomycin, gentamicin, and combination therapy all outperformed controls
- Mechanism: high local antibiotic concentrations overcome biofilm-associated infection; Masquelet technique combination promotes vascularized membrane formation
- All studies China-based; authors call for international multicenter RCTs to establish global external validity
Keywords: antibiotic-loaded bone cement, diabetic foot ulcer, osteomyelitis, amputation prevention, wound healing meta-analysis, local antibiotic delivery
Xin Li, Zunhong Liang — Hainan Medical University / Hainan General Hospital, Haikou, China