Rodriguez-Merchan E Carlos
Department of Orthopaedic Surgery, "La Paz" University Hospital-IdiPaz , Madrid, Spain.
Hosp Pract (1995). 2020 Oct;48(4):188-195. doi: 10.1080/21548331.2020.1769417. Epub 2020 May 27.
Total knee arthroplasty (TKA) is a widely used technique, the purpose of which is to improve or eliminate knee pain produced by osteoarthritis. One of the most severe complications of primary TKA is periprosthetic joint infection (PJI). To reduce the risk of PJI, some surgeons use antibiotic-loaded bone cement (ALBC) in primary TKA, but others do not. In other words, the routine use of ALBC in primary TKA is controversial.
The purpose of this article is to perform a narrative review of recent literature with the aim of answering the following question: Does ALBC reduce the risk of PJI 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 not considered. The main criteria for selection were articles that were focused on the role of ALBC in primary TKA.
One meta-analysis concluded that the prophylactic application of ALBC is not effective in preventing PJI in primary TKA. Two systematic reviews stated that the ALBC does not reduce the prevalence of PJI in primary TKA, so they consider it an unnecessary expense for health systems. One of these systematic reviews concluded that 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 suggested that in patients with diabetes mellitus who are treated with primary TKA, cement impregnated with cefuroxime is effective in preventing PJI.
It is logical to recommend the cautious use of ALBC, perhaps only in patients at high risk of infection (immunocompromised, morbid obesity, diabetics, and patients with a history of fracture or infection around the knee).
全膝关节置换术（TKA）是一种广泛应用的技术，其目的是改善或消除骨关节炎引起的膝关节疼痛。初次TKA最严重的并发症之一是假体周围关节感染（PJI）。为降低PJI风险，一些外科医生在初次TKA中使用含抗生素骨水泥（ALBC），而另一些医生则不使用。换句话说，初次TKA中常规使用ALBC存在争议。
本文旨在对近期文献进行叙述性综述，以回答以下问题：ALBC能否降低初次TKA中PJI的风险？
分析了与ALBC在初次TKA中的作用相关的Cochrane图书馆和PubMed（MEDLINE）搜索结果。仅检索英文文献。未考虑科学会议摘要和其他证据来源。主要选择标准是专注于ALBC在初次TKA中作用的文章。
一项荟萃分析得出结论，预防性应用ALBC在预防初次TKA中的PJI方面无效。两项系统评价指出，ALBC不会降低初次TKA中PJI的发生率，因此他们认为这对卫生系统来说是不必要的费用。其中一项系统评价得出结论，每年进行1000例初次TKA手术的医院系统，如果始终使用普通骨水泥，每年可节省15.5万美元至31万美元。一项前瞻性研究表明，在接受初次TKA治疗的糖尿病患者中，含头孢呋辛的骨水泥在预防PJI方面有效。
谨慎使用ALBC是合理的，可能仅适用于感染高危患者（免疫功能低下、病态肥胖、糖尿病患者以及有膝关节周围骨折或感染史的患者）。
