Efficacy of Adjunctive Antibiotic-Loaded Acrylic Bone Cement for Deep Surgical Site Infection Prophylaxis after Primary Cemented Hip and Knee Arthroplasties

Abstract

Purpose: The efficacy of antibiotic-loaded acrylic bone cements (ALBC) for prophylaxis of deep surgical site infections (deep SSIs) after primary cemented joint replacement surgery remains controversial. Therefore, the purpose of this study was to examine the issue, with respect to three types of arthroplasty, namely, total knee arthroplasty (TKA), total hip arthroplasty (THA), and bipolar hip arthroplasty (BHA). Methods:The records of 1,138 patients who received primary cemented TKAs, THAs, and BHAs between January 2006 and May 2013 were retrospectively reviewed. ALBC was used in 558 cases (ALBC group), and non-antibiotic-loaded acrylic bone cement was used in 580 cases (non-ALBC group). A logistic regression analysis was performed to determine the influence of ALBC on the incidence of SSI and to determine the risk factors associated with SSI. Results:The overall rate of deep SSI was 0.97% (1.4% in the ALBC group and 0.5% in the non-ALBC group), with the difference not being significant. Results of multivariate logistic regression analysis with the stepwise selection method showed that diabetes mellitus was one of the risk factors associated with the incidence of deep SSI after surgery. Conclusions:In the study population, ALBC did not prevent deep SSIs in primary cemented joint replacement, regardless of the type of joint replacement and whether or not the patient was diabetic.