Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review

Abstract

Purpose

Antibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA.

Methods

A detailed and systematic search of the Pubmed, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword “total knee arthroplasty” “total knee replacement” “total knee prosthesis” and “antibiotic-loaded bone cement” with no limit regarding the year of publication. We used modified Coleman scoring methodology (mCMS) to identify scientifically sound articles in a reproducible format. The review was limited to the English-language articles.

Results

Six articles met inclusion criteria. In total, 6318 arthroplasties were included in our study. 3217 of these arthroplasties received antibiotic-loaded bone cement and 3101 arthroplasties served as the control. There was no statistical difference between the two groups in terms of the incidence of deep or superficial surgical site infection. The average mCMS score was 67.6, indicating good methodological quality in the included studies.

Conclusions

Present review did not reveal any significant difference in terms of rate of deep or superficial surgical site infection in patients receiving antibiotic-loaded bone cement compared with the control (plain bone cement) during primary TKA. The clinical relevance of this study was that the use of antibiotic-loaded bone cement did not significantly reduce the risk of infection in primary TKA.

Level of evidence

III.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. 1.

    Bistolfi A, Massazza G, Verné E et al (2011) Antibiotic-loaded cement in orthopedic surgery: a review. ISRN Orthop 2011:290851

    PubMed  PubMed Central  Google Scholar 

  2. 2.

    Bourne RB (2004) Prophylactic use of antibiotic bone cement: an emerging standard—in the affirmative. J Arthroplasty 19(4 Suppl 1):69–72

    Article  PubMed  Google Scholar 

  3. 3.

    Buchholz HW, Engelbrecht H (1970) Depot effects of various antibiotics mixed with Palacos resins. Chirurg 41:511–515

    CAS  PubMed  Google Scholar 

  4. 4.

    Chiu FY, Chen CM, Lin CF et al (2002) Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees. J Bone Joint Surg Am 84-A:759–962

    PubMed  Google Scholar 

  5. 5.

    Chiang CC, Chiu FY (2012) Cefuroxime-impregnated cement and systemic cefazolin for 1 week in primary total knee arthroplasty: an evaluation of 2700 knees. J Chin Med Assoc 75:167–170

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Eveillard M, Mertl P, Tramier B et al (2003) Effectiveness of gentamicin-impregnated cement in the prevention of deep wound infection after primary total knee arthroplasty. Infect Control Hosp Epidemiol 24:778–780

    Article  PubMed  Google Scholar 

  7. 7.

    Gandhi R, Razak F, Pathy R et al (2009) Antibiotic bone cement and the incidence of deep infection after total knee arthroplasty. J Arthroplasty 24:1015–1018

    Article  PubMed  Google Scholar 

  8. 8.

    Gutowski CJ, Zmistowski BM, Clyde CT et al (2014) The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement. Bone Joint J 96-B:65–69

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Hansen EN, Adeli B, Kenyon R et al (2014) Routine use of antibiotic laden bone cement for primary total knee arthroplasty: impact on infecting microbial patterns and resistance profiles. J Arthroplasty 29:1123–1127

    Article  PubMed  Google Scholar 

  10. 10.

    Hanssen AD (2004) Prophylactic use of antibiotic bone cement: an emerging standard – in opposition. J Arthroplasty 19(4 Suppl 1):73–77

    Article  PubMed  Google Scholar 

  11. 11.

    Hanssen AD, Spangehl MJ (2004) Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements. Clin Orthop Relat Res 427:79–85

    Article  PubMed  Google Scholar 

  12. 12.

    Hinarejos P, Guirro P, Leal J et al (2013) The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am 95:769–774

    Article  PubMed  Google Scholar 

  13. 13.

    Hinarejos P, Guirro P, Puig-Verdie L et al (2015) Use of antibiotic-loaded cement in total knee arthroplasty. Word J Orthop 6:877–885

    Article  Google Scholar 

  14. 14.

    Kurtz SM, Ong KL, Lau E et al (2010) Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res 468:52–56

    Article  PubMed  Google Scholar 

  15. 15.

    Malik MH, Chougle A, Pradhan N et al (2005) Primary total knee replacement: a comparison of a nationally agreed guide to best practice and current surgical technique as determined by the North West Regional Arthroplasty Register. Am R Coll Surg Engl 87:117–122

    CAS  Article  Google Scholar 

  16. 16.

    Namba RS, Chen Y, Paxton EW et al (2009) Outcome of routine use of antibiotic-loaded cement in primary total knee arthroplasty. J Arthroplasty 24(6 Suppl):44–47

    Article  PubMed  Google Scholar 

  17. 17.

    Qadir R, Sidhu S, Ochsner JL et al (2014) Risk stratified usage of antibiotic-loaded bone cement for primary total knee arthroplasty: short term infection outcomes with a standardized cement protocol. J Arthroplasty 29:1622–1624

    Article  PubMed  Google Scholar 

  18. 18.

    Randelli P, Evola R, Cabitza P et al (2009) L’uso profilattico del cemento antibiotato nei primi impianti protesici del ginocchio. GIOT 35:122–128

    Google Scholar 

  19. 19.

    Randelli P, Evola FR, Cabitza P et al (2010) Prophylactic use of antibiotic-loaded bone cement in primary total knee replacement. Knee Surg Sports Traumatol Arthrosc 18:181–186

    Article  PubMed  Google Scholar 

  20. 20.

    Robertsson O, Knutson K, Lewold S et al (2001) The Swedish Knee Arthroplasty Register 1975–1997: an update with special emphasis on 41,223 knees operated on in 1988–1997. Acta Orthop Scand 72:503–513

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Shamseer L, Moher D, Clarke M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 349:g7647

    Article  PubMed  Google Scholar 

  22. 22.

    Srivastav AK, Nadkarni B, Srivastav S et al (2009) Prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty: justified or not? Indian J Orthop 43:259–263

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Tabulin J, D’Ollonne T, Cambas PM (2012) Antibiotic addition to cement—is it beneficial. Hip Int 22:9–12

    Article  Google Scholar 

  24. 24.

    Vasso M, Schiavone Panni A (2015) Low-grade periprosthetic knee infection: diagnosis and management. J Orthop Traumatol 16:1–7

    Article  PubMed  Google Scholar 

  25. 25.

    Vasso M, Schiavone Panni A, De Martino I et al (2016) Prosthetic knee infection by resistant bacteria: the worst-case scenario. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4010-8

    Google Scholar 

  26. 26.

    Wang H, Qiu G, Lin J et al (2014) Antibiotic bone cement cannot reduce deep infection after primary total knee arthroplastly. Orthopaedics 38:e462–e466

    Article  Google Scholar 

  27. 27.

    Wu CT (2016) Surgical site infection after total knee arthroplasty: risk factors in patient with timely administration of systemic prophylactic antibiotics. J Arthroplasty. doi:10.1016/j.arth.2016.01.017

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to K. Corona.

Ethics declarations

Conflict of interest

The authours declares that they have no conflict of interest.

Funding

No funding.

Ethical approval

All procedures performed in studies involving human partecipants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinski declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study format consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Schiavone Panni, A., Corona, K., Giulianelli, M. et al. Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review. Knee Surg Sports Traumatol Arthrosc 24, 3168–3174 (2016). https://doi.org/10.1007/s00167-016-4301-0

Download citation

Keywords

  • Total knee arthroplasty
  • Infection
  • Antibiotic-loaded bone cement
  • Plain bone cement