What Is the Role of Antibiotic-Containing Cement in Total Knee Arthroplasty?

Abstract

Despite a prevalence of <1% in most series, periprosthetic joint infection is a devastating complication that is of major concern to patients, surgeons, and payers because of its attendant disability, difficult treatment, and cost. Risk factors leading to periprosthetic joint infection and methods of prevention are difficult to investigate because these infections are uncommon and large patient populations are necessary for sufficient statistical power to differentiate between treatment methods or to identify causative factors. The May 1 issue of JBJS includes two important contributions toward understanding infection after total knee arthroplasty; however, both papers also demonstrate the problems attendant to investigating this clinical problem. Risk Factors Associated with Deep Surgical Site Infections After Primary Total Knee Arthroplasty by Namba et al. is an observational study of prospectively collected data on 56,216 patients treated with primary total knee arthroplasty derived from the total joint replacement registry of the Kaiser Permanente health system. As has been reported in other studies, the authors showed that deep surgical site infection was associated with obesity, male sex, osteonecrosis, posttraumatic arthritis, and duration of surgery. The authors found that Hispanic race was protective against deep infection as was the use of antibiotic irrigation. Paradoxically, they also found that antibiotic-containing bone …