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Use of Antibiotic-Impregnated Cement in Total Joint Arthroplasty

Dr. Joseph is resident, Department of Orthopaedic Surgery, Musculoskeletal Research Center, NYU–Hospital for Joint Diseases, New York, NY. Dr. Chen is resident, Department of Orthopaedic Surgery, Musculoskeletal Research Center, NYU–Hospital for Joint Diseases, New York. Dr. Di Cesare is Associate Professor of Orthopaedic Surgery, Department of Orthopaedic Surgery, Musculoskeletal Research Center, NYU–Hospital for Joint Diseases, New York.

Reprint requests: Dr. Di Cesare, 15th Floor, 301 East 17th Street, New York, NY 10003.

The use of antibiotic-impregnated cement in revision of total hip arthroplasty procedures is widespread, and a substantial body of evidence demonstrates its efficacy in infection prevention and treatment. However, it is not clear that it is necessary or desirable as a routine means of prophylaxis in primary total joint arthroplasty. In the management of infected implant sites, antibiotic-impregnated cement used in one-stage exchange arthroplasties has lowered reinfection rates. In two-stage procedures, use of beads and either articulating or nonarticulating antibiotic-impregnated cement spacers also has lowered reinfection rates. In addition, spacers reduce "dead space," help stabilize the limb, and facilitate reimplantation. Problems associated with antibiotic-impregnated cement in total joint arthroplasty include weakening of the cement and the generation of antibiotic-resistant bacteria in infected implant sites.

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