Antibiotic-Impregnated Cement in Revision Total Knee Arthroplasty

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.