Infection after primary total knee arthroplasty: a randomized controlled prospective study of the addition of antibiotics to bone cement *

Objective  The present prospective, randomized and controlled study was conducted with 286 patients submitted to primary total knee arthroplasty (TKA) with the objective of evaluating the efficacy of the addition of antibiotics to bone cement as a way to prevent post arthroplasty infection (PAI).

Methods  The patients were randomized into two groups: bone cement without antibiotic (No ATB, n  = 158) or cement with antibiotic (ATB, n  = 128), in which 2 g of vancomycin was added to 40 g of cement. The patients were followed up for 24 months after surgery.

Results  Regarding preoperative demographic data, the distribution of patients between groups was homogeneous ( p  < 0.05). In the 24-month period, the overall infection rate was of 2.09% (6/286), with no difference (odds ratio [OR] = 1.636; 95% confidence interval [CI]: 0.294–9.080; p  = 0.694) between the ATB group (1.56%; 2/128) and the No ATB group (2.53%; 4/158). In the No ATB group, the infection was caused by methicillin-resistant Staphylococcus aureus (MRSA) ( n  = 2), methicillin-sensitive S. aureus (MSSA) ( n  = 1) and Eschirichia coli ( n  = 1). Proteus mirabilis and MSSA were isolated from patients in the ATB group. Among the comorbidities, all patients with PAI were hypertensive and nondiabetic. Two rheumatoid arthritis patients who developed PAI were from the ATB group.

Conclusion  The use of cement with ATB reduced the absolute number of infections, but without statistical difference between the groups; thus, routine use should not be encouraged.