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Increased risk of aseptic loosening
26%
119/455
Increased risk of kidney injury
17%
78/455
Less cost
2%
7/455
Local tissue antibiotic toxicity
4%
20/455
Reduced rate of infection
50%
227/455
Select Answer to see Preferred Response
Low dose (<3% ratio of antibiotics to cement) antibiotic-loaded bone cement (ALBC) is associated with reduced periprosthetic joint infection (PJI) rate.ALBC is used with the goal of reducing deep infection following arthroplasty. Low-dose antibiotics (up to 3% antibiotic by volume) is safe to use without compromising the mechanical properties of the cement. While the results from some studies are mixed, the body of literature supports a reduced PJI rate with the use of ALBC, particularly in high-risk patients and in the revision setting. 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 (with high-dose antibiotics), and financial cost. 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 fewer 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 surprisingly higher in patients who received antibiotic-loaded bone cement; however, this was confounded by the fact that patients with a higher risk for infection were much more likely to receive antibiotic-loaded bone cement. In analyzing the results in diabetic patients only, there was no difference in the rate of post-operative deep infection. Incorrect Answers: Answer 1: Low-dose ALBC (<3% ratio of antibiotics to cement) is not associated with loosening.Answer 2: Systemic toxicity (e.g. kidney injury) has not been found to be a risk with low-dose ALBC.Answer 3: ALBC adds cost to the surgery, especially with cement that comes pre-loaded with antibiotics by the manufacturer.Answer 4: This is not a reported phenomenon with low-dose ALBC.
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