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Study: No reduction in deep infection rates from TKA involving antibiotic-loaded bone cement

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SAN FRANCISCO — Performing primary total knee arthroplasty using antibiotic-loaded bone cement does not appear to improve the rate of postoperative deep infection, according to a study presented here.

"We will continue to follow this cohort and report our findings in the future. At this time, the routine use of [antibiotic-loaded bone cement] for primary TKA (total knee arthroplasty) does not appear warranted," the authors said in the study.

Robert S. Namba, MD, and colleagues at Kaiser Permanente in Anaheim, Calif., investigated the rate of deep infection among 15,859 primary TKAs performed from May 2003 to April 2006. Data for all cases were included in a community-based total joint registry, an integrated administrative database and a comprehensive infection surveillance program, according to the study.

"The current study involves the collective experience of multiple community-based surgeons incorporating contemporary surgical techniques," they noted.

Namba and colleagues compared rates of deep infection between TKAs performed either with or without antibiotic-loaded bone cement, and between patients with and without diabetes.

The researchers defined deep infection using the U.S. Centers for Disease Control and Prevention criteria. They displayed their results in a poster at the American Academy of Orthopaedic Surgeons 75th Annual Meeting.

Overall, surgeons used antibiotic-loaded bone cement in 1,240 patients (7.8%). Of these, 14 patients (1.1%) developed a deep infection. In comparison, there was an infection rate of 0.7% among the remaining cases who did not receive cement (P=.09).

Among 3,339 patients with diabetes, 301 patients received antibiotic-loaded bone cement (9%). Investigators found that diabetic patients treated with antibiotic-loaded bone cement had a 1.3% rate of deep infection compared with 1.2% among diabetics who did not receive such cement (P=.83), according to the study.

"There was no significant reduction of primary TKA deep infections with the use of [antibiotic-loaded bone cement] in our series, even in diabetic patients," the authors said in the study.

For more information:

• Namba RS, Dee D, Paxton EW, Fithian DC. Low-dose antibiotic loaded cement did not lower primary TKA infection rates. P195. Presented at the American Academy of Orthopaedic Surgeons 75th Annual Meeting. March 5-9, 2008. San Francisco.