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. 2019 Sep;34(9):2091-2095.e1.
doi: 10.1016/j.arth.2019.04.033. Epub 2019 Apr 22.

Effect of Antibiotic-Impregnated Bone Cement in Primary Total Knee Arthroplasty

Hiba K Anis  1 , Nipun Sodhi  1 , Mhamad Faour  2 , Alison K Klika  1 , Michael A Mont  1 , Wael K Barsoum  2 , Carlos A Higuera  2 , Robert M Molloy  1
Affiliations

Effect of Antibiotic-Impregnated Bone Cement in Primary Total Knee Arthroplasty

Hiba K Anis et al. J Arthroplasty. 2019 Sep.

Erratum in

Abstract

Background: The purpose of this study is to evaluate the effect of commercially available antibiotic-impregnated bone cement (AIBC) on (1) prosthetic joint infections (PJIs) and (2) surgical site infections (SSIs) after primary total knee arthroplasty (TKA).

Methods: A review of primary TKAs between 2014 and 2017 from an institutional database was conducted. This identified 12,541 cases which were separated into AIBC (n = 4337) and non-AIBC (8,164) cohorts. Medical records were reviewed for PJIs and SSIs (mean 2-year postoperative period). Infection rates between the cohorts were compared with univariate analyses followed by subanalysis of high risk patients (defined as having 2 or more of the following characteristics: >65 years, body mass index >40, or Charlson Comorbidity Index score >3). To control for confounders, multivariate analyses were performed with regression models adjusted for age, gender, body mass index, comorbidities, year, operative times, and lengths of stay.

Results: On univariate analysis, PJI rates were higher in the AIBC cohort (1.0%) compared to the non-AIBC cohort (0.5%, P < .001). Subanalysis of the high risk patients also showed that PJI rates were higher in the AIBC cohort (1.9% vs 0.6%, P < .01). After adjusting for potential confounders, no significant associations between PJIs and AIBC use were found (odds ratio 1.4, 95% confidence interval 0.9-2.3, P = .133). Similarly, no significant differences in SSI rates were observed between the AIBC (2.9%) and non-AIBC cohorts (2.4%, P = .060) and no significant associations between SSIs and AIBC were found with multivariate analysis (odds ratio 1.0, 95% confidence interval CI 0.8-1.3, P = .948).

Conclusion: This study found that there was no clinically or statistically significant decrease in infection rates with AIBC in primary TKAs.

Keywords: antibiotic cement; postoperative infection; prosthetic joint infection; surgical site infection; total knee arthroplasty.

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