Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

Table 1 Data from primary total knee arthroplasty randomized controlled trials

Paper	AIBC group number of TKAs infected	Infection rate of AIBC group	Non-AIBC number of TKAs infected	Infection rate of non-AIBC group	Reason for procedure	Follow-up (mo)
Chiu et al[18], 2001	0/41	0	5/37	0.13514	Osteoarthritis	50
Vrabec et al[23], 2016	0/10	0	0/5	0	N/A	12
Chiu et al[19], 2002	0/178	0	5/162	0.03086	N/A	49
Lizaur-Utrilla et al[24], 2014	1/48	0.020833	0/45	0	Non-inflammatory arthritis	76.8
Nilsson et al[25], 1999	0/28	0	2/29	0.068966	Osteoarthritis and Rheumatoid arthritis	60
Bercovy et al[26] , 2012	2/164	0.012195	1/157	0.006369	N/A	91.2
Hinarejos et al[20], 2013	20/1483	0.013486	20/1465	0.013652	N/A	38
McQueen et al[22], 1987	0/13	0	1/13	0.076923	Osteoarthritis and rheumatoid arthritis	24
McQueen et al[21], 1990	0/14	0	1/11	0.090909	Osteoarthritis	24
	Total: 23/1979 (1.16%)		Total: 35/1924 (1.82%)			Average: 47.2

AIBC: Antibiotic impregnated bone cement; TKA: Total knee arthroplasty.

Table 2 Data from revision TKA RCTs

Paper	AIBC group number of TKAs infected	Infection rate of AIBC group	Non-AIBC number of TKAs infected	Infection rate of non-AIBC group	Reason for procedure	Follow-up (mo)
Nelson et al[27], 1993	0/3	0	0/3	0	Previous infection	36
Chiu et al[17], 2009	0/93	0	7/90	7.78%	Osteoarthritis	89
	Total: 0/96 (0.00%)		Total: 7/93 (7.53%)			Average: 62.5

RCTs: Randomized controlled trials/studies; AIBC: Antibiotic impregnated bone cement; TKA: Total knee arthroplasty.

Table 3 Comparisons made between groups in primary TKA RCTs

Paper	Comparison
Chiu et al[18], 2001	Cefuroxime-impregnated cement vs PBC
Vrabec et al[23], 2016	Intravenous tobramycin vs AIBC with tobramycin
Chiu et al[19], 2002	Cefuroxime-impregnated cement vs PBC
Lizaur-Utrilla et al[24], 2014	Tibial fixation with either a cemented (Palacos with Gentamicin) vs cementless with screw augmentation (systemic antibiotics only)
Nilsson et al[25], 1999	Vacuum mixed bone cement (Palacos–Gentamicin) vs hydroxyapatite-coated prostheses
Bercovy et al[26], 2012	Hydroxyapatite-coated prostheses vs cemented (Refobacin) tibial components
Hinarejos et al[20], 2013	Simplex P cement loaded with 0.5 g of erythromycin and three million units of colistin in 40 g of cement (Stryker) vs simplex cement without antibiotic
McQueen et al[22], 1987	Cefuroxime in bone cement (1.5 g of cefuroxime powder was added to 40 g of CMW cement powder) vs systemic (1.5 g) cefuroxime
McQueen et al[21], 1990	Cefuroxime in bone cement (1.5 g of cefuroxime powder was added to 40 g of CMW cement powder) vs systemic (1.5 g) cefuroxime

CMW: A kind of bone cement made by CMW laboratories of DePuy Synthes Companies; RCTs: Randomized controlled trials/studies; PBC: Plain bone cement; AIBC: Antibiotic impregnated bone cement.

Table 4 Comparisons made between groups in revision TKA RCTs

Paper	Comparison
Nelson et al[27], 1993	Gentamicin-PMMA beads vs conventional systemic antibiotics
Chiu et al[17], 2009	AIBC (vancomycin-impregnated) vs PBC in TKA Revision

RCTs: Randomized controlled trials/studies; PMMA: Polymethyl methacrylate; AIBC: Antibiotic impregnated bone cement; TKA: Total knee arthroplasty; PBC: Plain bone cement.

Table 5 HSS, KSS knee scores, and loosening rates

Paper	Statistically significant differences in deep infection rate	HSS knee score AIBC	HSS knee score non-AIBC	KSS score AIBC	KSS score non-AIBC	Loosening AIBC	Loosening non-AIBC
Chiu et al[18], 2001	Yes (P = 0.021)	91	86	-	-	0/41	2/37
Vrabec et al[23], 2016	No (P value not reported)	-	-	-	-	-	-
Chiu et al[19], 2002	Yes (P = 0.0238)	90	88	-	-	1/178	0/162
Lizaur-Utrilla et al[24], 2014	No (P value not reported)	-	-	89	94	4/48	1/45
Nilsson et al[25], 1999	No (P value not reported)	-	-	93	93	0/28	1/29
Bercovy et al[26], 2012	No (P value not reported)	-	-	94.3	94.6	1/164	1/157
Hinarejos et al[20], 2013	No (P = 0.96)	-	-	-	-	-	-
McQueen et al[22], 1987	No (P value not reported)	-	-	-	-	-	-
McQueen et al[21], 1990	No (P value not reported)	-	-	-	-	-	-
Nelson et al[27], 1993	No (P value not reported)	-	-	-	-	-	-
Chiu et al[17], 2009	Yes (P = 0.0130)	87	85	-	-	0/93	0/90

AIBC: Antibiotic impregnated bone cement; HSS: Hospital for special surgery scores; KSS: Knee society scores.