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Use of antibiotic-loaded cement in total knee arthroplasty.

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dc.contributor.author Hinarejos Gómez, Pedro Angel
dc.contributor.author Guirro Castellnou, Pau
dc.contributor.author Puig Verdié, Luís
dc.contributor.author Torres Claramunt, Raúl
dc.contributor.author Leal Blanquet, Joan
dc.contributor.author Sánchez Soler, JF.
dc.contributor.author Monllau García, Juan Carlos
dc.date.accessioned 2016-01-22T07:58:48Z
dc.date.available 2016-01-22T07:58:48Z
dc.date.issued 2015
dc.identifier.citation Hinarejos P, Guirro P, Puig-Verdie L, Torres-Claramunt R, Leal-Blanquet J, Sanchez-Soler J. et al. Use of antibiotic-loaded cement in total knee arthroplasty. World J Orthop. 2015 Dec 18;6(11):877-85. doi: 10.5312/wjo.v6.i11.877.
dc.identifier.issn 2218-5836
dc.identifier.uri http://hdl.handle.net/10230/25636
dc.description.abstract Bone cement has the capacity to release antibiotic molecules if any antibiotic is included in it, and these elution properties are improved as cement porosity is increased. In vitro studies have shown high local antibiotic concentration for many hours or few days after its use. Antibiotic loaded bone cement (ALBC) is helpful when treating an infection in total knee arthroplasty (TKA) revision surgery. The purpose of this paper was to review the evidence for the routine use of ALBC in TKA in the literature, its pros and cons. Many authors have recommended the use of ALBC also in primary TKA for infection prophylaxis, but the evidence based on data from National Registries, randomized clinical trials and meta-analysis suggest a protective effect of ALBC against infection when used in hips, but not (or only mild) in knees. A possible explanation to this finding is that the duration and quantity of locally elevated antibiotic levels after surgery are smaller in TKA, due to the smaller amount of cement used for fixation in TKA-only a layer in the bone surface. There are some concerns about the routine use of ALBC in primary TKA as prophylaxis against infection: Firstly, there is a risk of hypersensivity or toxicity even when the chance is highly improbable. Secondly, there is a reduction in the mechanical properties of the cement, but this can be probably neglected if the antibiotic is used in low doses, not more than 1 g per 40 g cement package. Another significant concern is the increased economic cost, which could be overlooked if there were enough savings in treating fewer prosthetic infections. Finally, there is also a risk of selection of antibiotic-resistant strains of bacteria and this could be the main concern. If used, the choice of the antibiotic mixed in ALBC should consider microbiological aspects (broad antimicrobial spectrum and low rate of resistant bacteria), physical and chemical aspects (thermal stability, high water solubility), pharmacological characteristics (low risk to allergic reactions or toxicity) and economic aspects (not too expensive). The most commonly used antibiotics in ALBC are gentamicin, tobramycin and vancomycin. In conclusion, there is a paucity of randomized clinical trials in the use of ALBC in primary TKAs and the actual evidence of the effect of ALBC in reducing the risk of infection is insufficient. This, in addition to concerns about patient safety, risks of increase in the antibiotic resistance of microorganisms and the increase in costs in the procedure, lead us to recommend a cautious use of ALBC, perhaps only in high-risk patients (immunocompromised, morbidly obese, diabetic and patients with previous history of fracture or infection around the knee) unless the benefits of ALBC use were fully proven. Meanwhile, the rigorous use of peri-operative prophylactic systemic antibiotics and adoption of efficient antiseptic procedures and improved surgical techniques must be considered the gold standard in infection prevention in TKA surgery.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Baishideng Publishing Group
dc.relation.ispartof World Journal of Orthopedics. 2015 Dec 18;6(11):877-85
dc.rights © 2015 Baishideng Publishing Group Inc. This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org//nlicenses/by-nc/4.0/
dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
dc.subject.other Antibiòtics
dc.subject.other Artroplàstia total de genoll
dc.title Use of antibiotic-loaded cement in total knee arthroplasty.
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.5312/wjo.v6.i11.877
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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