Abstract
Introduction:
Deep infection after total joint arthroplasty is a devastating complication with reported incidence of 1–3% with projection to increase to 6.8% by 2030. The direct costs of revision surgery due to septic failure are estimated at over $55,000 per case. Antibiotic-Loaded Bone Cement (ALBC) has been proposed as a preventive measure to decrease post-operative infection rates. Its efficacy has been compared with plain bone cement (PBC) in multiple studies. There has been no study to our knowledge examining its efficacy in “high risk” patients. The purpose of this study is to compare infection rates in three cohorts of patients: (1) all patients receiving only PBC, (2) all patients receiving only ALBC, and (3) only “high risk” patients receiving ALBC.
Methods:
A standard cement protocol was instituted at our hospital for primary total knee arthroplasties (pTKA). From January 2000 to 2005 all pTKAs were performed with PBC. From February 2005 to May 2010, all pTKAs were performed with ALBC. From June 2010 to March 2012, all patients received regular bone cement unless they had previous diagnoses of rheumatoid arthritis, obesity, and/or diabetes mellitus. Our institutional joint registry was queried and the three cohorts' individual charts were retrospectively reviewed. Infection rates amongst cohorts were compared at 30 days, 6 months, and 1 year from index surgery date utilizing two sided proportion tests.
Results:
A total of 3,292 consecutive primary TKAs with full follow up were included. Overall infection rate at one year for the entire study was 0.76%. There were 1,025 patients who received PBC, 1486 ALBC, and 781 in the risk stratified cohort. The 30-day infection rates for cohorts 1, 2, 3 were .0.29%, 0.20%, and 0.13% respectively. The 6-month infection rates for cohorts 1, 2, 3 were 0.39%, 0.54% and 0.38% respectively. The 1-year infection rate for cohorts 1, 2, 3 were 0.78%, 0.61%, and 0.64% respectively. The differences in infection rates between each cohort at all three time intervals were not statistically significant.
Conclusions:
Antibiotic loaded bone cement does not significantly decrease infection rates for primary total knee arthroplasty. Even risk stratified usage of ALBC for “high risk” patients may be unnecessary and add undue costs to both the patient and hospital, without any appreciable benefit.
