Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees.
BACKGROUND
Deep infection following total knee arthroplasty is a devastating complication, and it is very important to prevent it. A prospective cohort study was conducted to evaluate the effect of vancomycin-impregnated cement on the prevention of deep infection after revision total knee arthroplasty performed in a setting in which so-called clean-air measures such as laminar flow and space suits were not available.


METHODS
From 1993 to 2004, 183 first-time revision total knee arthroplasties were performed with fixation of all components with cement. The knees were divided randomly into two groups to evaluate the effect of vancomycin-impregnated cement in the prevention of postoperative infection. In Group 1 (ninety knees), the cement was not mixed with antibiotics; in Group 2 (ninety-three knees), vancomycin-impregnated cement was used for fixation. All of the patients were evaluated preoperatively and intraoperatively and found to be without infection at those times.


RESULTS
At an average of eighty-nine months postoperatively, no deep infection had developed in the ninety-three knees in Group 2, whereas a deep infection had developed in six (7%) of the ninety knees in Group 1. This difference between Groups 1 and 2 was significant (p = 0.0130). One superficial wound infection developed in Group 1.


CONCLUSIONS
Vancomycin-impregnated cement was shown to be effective in the prevention of postoperative deep infection after revision total knee arthroplasty performed with antibiotic prophylaxis but not with so-called clean-air measures. This study provides preliminary evidence to justify larger trials.
Chiu
Fang-Yao
FY
Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan 11217, Republic of China. fychiu@vghtpe.gov.tw
Lin
Chien-Fu Jeff
CF
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012086:Reoperation; D012307:Risk Factors; D014640:Vancomycin / Q000008:administration & dosage*
D000900:Anti-Bacterial Agents; D001843:Bone Cements; D014640:Vancomycin