title: The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees.
abstract: BACKGROUND
  The use of antibiotic-loaded cement is believed to prevent infection in primary total knee arthroplasty, but there is a lack of randomized studies to support this concept. The aim of this study was to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty.
  
  
  METHODS
  This is a prospective randomized study with 2948 cemented total knee arthroplasties, in which bone cement without antibiotic was used in 1465 knees (the control group) and a bone cement loaded with erythromycin and colistin was used in 1483 knees (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention.
  
  
  RESULTS
  The rate of deep infection (1.4% in the control group and 1.35% in the study group; p = 0.96) and the rate of superficial infection (1.2% and 1.8%, respectively; p = 0.53) were similar in both groups. The factors related to a higher rate of deep infection in a multivariate analysis were male sex and an operating time of >125 minutes.
  
  
  CONCLUSIONS
  The use of erythromycin and colistin-loaded bone cement in total knee arthroplasty did not lead to a decrease in the rate of infection when systemic prophylactic antibiotics were used, a finding that suggests that the use of antibiotic-loaded bone cement would not be indicated in the general population. Further research is needed to assess whether its use is recommended for patients with a higher risk of infection.
authors: Department of Orthopedic Surgery, Parc de Salut Mar, Universitat Autònoma Barcelona, Hospital de la Esperanza, Sant Josep de la Muntanya, 12, 08024 Barcelona, Spain. Phinarejos@parcdesalutmar.cat
authors: Pedro
authors: P
authors: Hinarejos
authors: Pau
authors: P
authors: Guirro
authors: Joan
authors: J
authors: Leal
authors: Ferran
authors: F
authors: Montserrat
authors: Xavier
authors: X
authors: Pelfort
authors: M L
authors: ML
authors: Sorli
authors: J P
authors: JP
authors: Horcajada
authors: Lluis
authors: L
authors: Puig
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D003091:Colistin / Q000008:administration & dosage*; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements; D004917:Erythromycin; D003091:Colistin