Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review.
OBJECTIVE
Antibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA.


METHODS
A detailed and systematic search of the Pubmed, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword "total knee arthroplasty" "total knee replacement" "total knee prosthesis" and "antibiotic-loaded bone cement" with no limit regarding the year of publication. We used modified Coleman scoring methodology (mCMS) to identify scientifically sound articles in a reproducible format. The review was limited to the English-language articles.


RESULTS
Six articles met inclusion criteria. In total, 6318 arthroplasties were included in our study. 3217 of these arthroplasties received antibiotic-loaded bone cement and 3101 arthroplasties served as the control. There was no statistical difference between the two groups in terms of the incidence of deep or superficial surgical site infection. The average mCMS score was 67.6, indicating good methodological quality in the included studies.


CONCLUSIONS
Present review did not reveal any significant difference in terms of rate of deep or superficial surgical site infection in patients receiving antibiotic-loaded bone cement compared with the control (plain bone cement) during primary TKA. The clinical relevance of this study was that the use of antibiotic-loaded bone cement did not significantly reduce the risk of infection in primary TKA.


METHODS
III.
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy.
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Schiavone Panni
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy. katia.corona@unimol.it.
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http://orcid.org/0000-0002-3456-8361
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Corona
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy.
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Giulianelli
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy.
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Mazzitelli
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy.
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C
Del Regno
Department of Medicine and Science for Health, University of Molise, via Francesco De Sanctis, Campobasso, Italy.
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Vasso
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019645:Arthroplasty, Replacement, Knee; D001843:Bone Cements; D006801:Humans; D007720:Knee Prosthesis; D016459:Prosthesis-Related Infections / Q000517:prevention & control*
D000900:Anti-Bacterial Agents; D001843:Bone Cements
Antibiotic-loaded bone cement; Infection; Plain bone cement; Total knee arthroplasty