Abstract
Despite the prophylactic use of antibiotics and hygienic strategies, surgical site infection following total joint arthroplasty (TJA) is still a severe and unsolved complication. Since antibiotic-loaded bone cement (ALBC) was introduced by Buchholz in the 1970s, the use of ALBC has been increasingly used for the prevention and treatment of periprosthetic infection (PPI). However, the routine use of ALBC during primary TJA remains controversial. Recent clinical studies have found that ALBC is effective in reducing the risk of PJI following primary TJA. Although ALBC having the advantage of reducing the risk of PJI, the main disadvantages are the possible development of toxicity, antibiotic resistance, allergic reaction, and possible reduction of the mechanical properties of bone cement. Nevertheless, a recent published article demonstrated, that the use of high dose dual-antibiotic impregnated cement reduce significantly the rate of surgical site infections compared to standard low dose single ALBC in the setting of a hip fracture treating with hemiarthroplasty. Furthermore, Sanz-Ruiz et al. presented that the use of ALBC in TJA has favorable cost-efficiency profile. In this context, reasons why surgeons should use antibiotic-loaded bone cement during primary TJA are demonstrated.
