At the July 2018 meeting of the International Consensus Meeting (ICM) hosted by Jefferson Health in Philadelphia, a team of specialists tackled vital issues regarding musculoskeletal infection. A particularly hot topic at this year’s meeting was the concept of antibiotic-impregnated cement.
Javad Parvizi, M.D., co-host of the meeting and director of clinical research at the Rothman Institute at Jefferson, explained the issue OTW, “Antibiotic-impregnated cement was initially introduced under the notion that its use led to a reduction in the infection rate in total joint arthroplasty. In the 1980s and ‘90s the Norwegian data registry did indeed show that patients who had received antibiotic-impregnated cement during total hip replacement had a lower rate of failure compared to those who did not have it.”
“There were a couple of systematic reviews published on this as well, so the common thinking was that using antibiotic-impregnated cement did lead to a reduction in the infection rate. The 2013 consensus meeting recommended that antibiotic-impregnated cement be used in patients at a high risk of infection.”
As for the notion that we should move toward using this cement in all primary arthroplasties, Dr. Parvizi cautions: “There are two major—and several minor—questions that need to be addressed.”
“Is antibiotic-impregnated cement truly efficacious in prevention of infection? The registry data is not sophisticated enough to answer this question for us. Second, does the cost justify its use in primary joint replacement? The cost of antibiotic impregnated cement is substantial.”
“Then there are a host of other issues related to the use of antibiotic-impregnated cement, such as the potential for emergence of antibiotic-resistant organisms, hypersensitivity of patient to the cement, the potential of cement to be weakened by the addition of the antibiotic, etc.”
“The debate raged on at this year’s meeting with the British contingent pointing to their registry data. They had a study that included 731,214 total knee replacements, 15,295 of which were implanted plain and 97.9% with antibiotic-impregnated cement. There were 13,391 revisions, of which 2,391 were performed for infection. After adjusting for other variables, antibiotic-impregnated cement DID NOT reduce the risk of infection.
“Then there is the study that included data from the National Joint Registry for England and Wales and included 199,205 primary total hip replacements. Their finding? That revision rates were similar between plain and antibiotic-impregnated cement. Obviously, we are not in a place to be recommending the use of this cement in all total joint surgeries. As of now it should be limited to those patients who have the highest risk of infection. The document also contains a wealth of new materials that hopefully stands to improve patient care.”
