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This article aimed to perform a narrative review of recent literature to determine whether ALBC minimizes PJI risk in primary TKA.
One of the most severe complications of primary total knee arthroplasty (TKA) is PJI (periprosthetic joint infection). To minimize PJI risk, some surgeons use ALBC (antibiotic loaded bone cement) in primary TKA, but others do not. However, the routine use of ALBC in primary TKA is controversial. The study results depicted that the cautious use of ALBC is recommended perhaps only in patients at high risk of infection (diabetics, immunocompromised, morbid obesity, and patients with a history of fracture or infection around their knee).
This article aimed to perform a
narrative review of recent literature to determine whether ALBC minimizes PJI
risk in primary TKA.
A Cochrane Library and PubMed
(MEDLINE) search related to the role ALBC in primary TKA was analyzed. The only
language searched was English. Scientific meeting abstracts and other sources
of evidence were excluded. The primary criteria for selection were articles
that were focused on ALBC's role in primary TKA.
One meta-analysis depicted that in primary TKA, the prophylactic application of ALBC is not effective in preventing PJI. According to two systematic reviews, the ALBC does not minimize the prevalence of PJI in primary TKA. So, they consider it an unnecessary expense for health systems.
One of these systematic reviews illustrated that those hospital systems that perform 1000 primary TKA operations per year can save between $155,000 and $310,000 per year if they always use plain cement. A prospective study demonstrated that in patients with diabetes mellitus who are treated with primary TKA, cement impregnated with cefuroxime is effective in preventing PJI.
Cautious
use of ALBC is recommended only in patients at high risk of infection.
HOSPITAL PRACTICE
Antibiotic-loaded bone cement in primary total knee arthroplasty: does it reduce the risk of periprosthetic joint infection?
E. Carlos Rodriguez-Merchan
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