The Journal of Bone and Joint Surgery (American). 2009;91:628-633.
doi:10.2106/JBJS.G.01570
© 2009 The Journal of Bone and Joint Surgery, Inc.
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Antibiotic-Impregnated Cement in Revision Total Knee Arthroplasty

A Prospective Cohort Study of One Hundred and Eighty-three Knees

Fang-Yao Chiu, MD1 and Chien-Fu Jeff Lin, MD, PhD1

1 Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-pai Road, Taipei, Taiwan 11217, Republic of China. E-mail address for F.-Y. Chiu: fychiu{at}vghtpe.gov.tw

Investigation performed at the Department of Orthopedics and Traumatology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, Republic of China

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Deep infection following total knee arthroplasty is a devastating complication, and it is very important to prevent it. A prospective cohort study was conducted to evaluate the effect of vancomycin-impregnated cement on the prevention of deep infection after revision total knee arthroplasty performed in a setting in which so-called clean-air measures such as laminar flow and space suits were not available.

Methods: From 1993 to 2004, 183 first-time revision total knee arthroplasties were performed with fixation of all components with cement. The knees were divided randomly into two groups to evaluate the effect of vancomycin-impregnated cement in the prevention of postoperative infection. In Group 1 (ninety knees), the cement was not mixed with antibiotics; in Group 2 (ninety-three knees), vancomycin-impregnated cement was used for fixation. All of the patients were evaluated preoperatively and intraoperatively and found to be without infection at those times.

Results: At an average of eighty-nine months postoperatively, no deep infection had developed in the ninety-three knees in Group 2, whereas a deep infection had developed in six (7%) of the ninety knees in Group 1. This difference between Groups 1 and 2 was significant (p = 0.0130). One superficial wound infection developed in Group 1.

Conclusions: Vancomycin-impregnated cement was shown to be effective in the prevention of postoperative deep infection after revision total knee arthroplasty performed with antibiotic prophylaxis but not with so-called clean-air measures. This study provides preliminary evidence to justify larger trials.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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