Antibiotic impregnated bone cement is used with the goal of reducing deep infection following arthroplasty. The benefits must be weighed against the risks including altering the mechanical properties of the cement, risk of systemic absorption of antibiotics, increased risk of aseptic loosening, and financial cost. The evidence to date most strongly supports the use of antibiotic cement in patients undergoing revision arthroplasty. Chiu et al conducted a prospective randomized study of 183 revision knee arthroplasties in which one group of patients' components were secured with vancomycin impregnated cement and the other group received cement without antibiotics. Significantly less deep infections occurred in the group with vancomycin impregnated cement (6 infections vs. 0). Namba et al performed an observational study of 22,889 primary TKA's from a large HMO. Nine percent received antibiotic loaded bone cement. The rate of infection was higher in patients who received antibiotic loaded bone cement. Surprisingly, in analyzing the results in diabetic patients only, there was no difference in the rate of post-operative deep infection. There are significant limitations to this study as patients with a higher risk for infection were much more likely to receive antibiotic loaded bone cement.
Chiu FY, Lin CF. Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees. J Bone Joint Surg Am. 2009 Mar 1;91(3):628-33.
PMID:19255223 (Link to Abstract)
Karrholm J, Garellick G, Rogmark C, et al: Swedish Hip Arthroplasty Register: Annual Report 2007. Department of Orthopaedics, Shlgrenska University Hospital, September 2008.
Namba RS, Chen Y, Paxton EW, Slipchenko T, Fithian DC. Outcomes of routine use of antibiotic-loaded cement in primary total knee arthroplasty. J Arthroplasty. 2009 Sep;24(6 Suppl):44-7. Epub 2009 Jul 4.
PMID:19577881 (Link to Abstract)