Adding antibiotics to the cement used during total knee replacement did not appear to have any impact on the risk of revision within 2 years, according to Canadian researchers who presented results of their study at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
“There is considerable debate regarding the benefits of antibiotic bone cement in total knee replacement (TKR),” Eric R. Bohm, MD, said. “There are some theoretical concerns around the cement strength and antibiotic-resistant organisms … we proposed a question: Does the use of antibiotic-coated bone cement reduce the risk of early revision following primary [TKR]?”
Bohm and his team used databases to identify 36,681 patients with degenerative arthritis who underwent primary TKR. This cohort was then stratified to determine which patients had received revisions within 2 years, as well as the reasons for revision. The presence or absence of antibiotics in the cement was noted, as well as age, gender, comorbidities and presence of diabetes.
According to the study abstract, 16,665 of the patients received a TKR with antibiotic cement, while the rest received a TKR without antibiotics. There were 532 revisions, for an overall 2-year revision rate of 1.45% — 1.51% in the antibiotic group and 1.4% in the non-antibiotic group.
Bohm noted that further revision data were available on 206 of the 532 patients. These data revealed the non-antibiotic group experienced twice as many aseptic loosening-related revisions as the antibiotic group. However, infection-related revision rates and pain of unknown origin rates were no different between the groups.
“It appears the addition of antibiotics to cement for primary TKR in osteoarthritis has no clinically important effect on the risk of revision within 2 years of surgery,” Bohm said. “Longer follow-up, as well as confirmation of these findings in other national registries is warranted.”
- Bohm ER, Gu J, Zhu N, et al. The addition of antibiotics to cement does not appear to lower the risk of early revision in knee replacement surgery. Paper #133. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.