Purpose: Prophylactic use of antibiotic-laden bone cement (ALBC) has been proposed to decrease the incidence of deep infections. We asked if the use of antibiotic laden bone cement decreased the deep infection rate following primary total knee replacement (TKA) as compared to plain bone cement (PBC).

Method: We surveyed 1,625 consecutive patients undergoing cemented, primary knee replacement with either ALBC or PBC. Relevant covariates including age, body mass index (BMI), gender, education, and medical comorbidity were collected. Joint pain and functional status were assessed at baseline and at 1 year follow up with the respective Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores. The incidence of deep infection at 1 year follow up was recorded.

Results: There were 811 (49.9%) patients in the ALBC group and 814(50.1%) in the PBC group. There were no differences in age, gender, BMI, education or comorbidity between groups at baseline (p> 0.05). We found a deep infection rate of 3.1% in the ALBC group and 2.2% in the PBC group (p=0.27). Adjusted analysis showed that ALBC was not predictive of a lower infection rate at 1 year (p=0.84).

Conclusion: ALBC did not reduce the incidence of deep infection following primary TKA at 1 year follow up. Further studies are needed to define any high risk groups for which ALBC might be beneficial.

Purpose: Metabolic syndrome (MS) is defined as central adiposity, elevated fasting glucose, hypertension, and dyslipidemia defined as high triglyceride and low high-density lipoprotein (HDL) cholesterol. MS is associated with a systemic proinflammatory and prothrombotic state. We asked if patients with MS undergoing total knee arthroplasty (TKA) have an increased risk for symptomatic deep vein thrombosis at 3 months follow-up (DVT).

Method: 1,460 consecutive patients were reviewed from our joint registry undergoing primary, unilateral TKA between the years of 1998–2006. Demographic variables of age, gender, comorbidity, and education were retrieved. Metabolic syndrome (MS) was defined as body mass index above 30 kg/m2, diabetes, hypertension, and hypercholesterolemia. Logistic regression was used to examine the relationship of MS on the incidence of DVT.

Results: The overall incidence of symptomatic DVT was 4.4% (65/1460). Patients with MS had an increased incidence of DVT as compared to those without MS(15.5% vs 3.4%). Adjusted analysis showed that MS increased the risk of symptomatic DVT by 3.2(95% CI [1.0,15.4], p=0.04) times compared to those without MS.

Conclusion: Hospital protocols developed for prophylactic anti-coagulation following TKR should give special consideration to patients with MS.