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.
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.
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.
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.
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Bistolfi A, Massazza G, Verné E et al (2011) Antibiotic-loaded cement in orthopedic surgery: a review. ISRN Orthop 2011:290851
Bourne RB (2004) Prophylactic use of antibiotic bone cement: an emerging standard—in the affirmative. J Arthroplasty 19(4 Suppl 1):69–72
Buchholz HW, Engelbrecht H (1970) Depot effects of various antibiotics mixed with Palacos resins. Chirurg 41:511–515
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
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
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
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
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
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
Hanssen AD (2004) Prophylactic use of antibiotic bone cement: an emerging standard – in opposition. J Arthroplasty 19(4 Suppl 1):73–77
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
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
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
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
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
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
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
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
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
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
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
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
Tabulin J, D’Ollonne T, Cambas PM (2012) Antibiotic addition to cement—is it beneficial. Hip Int 22:9–12
Vasso M, Schiavone Panni A (2015) Low-grade periprosthetic knee infection: diagnosis and management. J Orthop Traumatol 16:1–7
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
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
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
Conflict of interest
The authours declares that they have no conflict of interest.
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.
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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
- Total knee arthroplasty
- Antibiotic-loaded bone cement
- Plain bone cement