Document Type : SYSTEMATIC REVIEW
Authors
1
Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran;
2
Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran;
3
Toxicology Research Center, Aja University of Medical Sciences, Tehran, Iran
4
Department of Orthopedic Surgery, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
5
1.Cancer Epidemiology Research Center, Aja University of Medical Sciences, Tehran, Iran 2.Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran
6
1.Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran 2.Student research committee, Aja university of medical sciences, Tehran, Iran
7
1.Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran 2.Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran;
8
1. Toxicology Research Center, Aja University of Medical Sciences, Tehran, Iran 2. Student research committee, Aja university of medical sciences, Tehran, Iran
9
1.Trauma and Surgery Research Center, Aja University Of Medical Sciences, Tehran, Iran 2.Biomaterial and Medicinal Chemistry Research Center, Aja University of Medical Science, Tehran, Iran;
10.22038/abjs.2026.91856.4161
Abstract
Effects of Antibiotic-Loaded Bone Cement on the Risk of Periprosthetic Joint Infection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Objectives: The use of antibiotic-loaded bone cement (ALBC) is a common strategy for preventing periprosthetic joint infection (PJI) after total knee arthroplasty (TKA), but its effectiveness is a subject of ongoing debate. This study aimed to provide a definitive, evidence-based recommendation for the use of ALBC versus plain bone cement (PBC) to prevent PJI after TKA.
Methods: This systematic review and meta-analysis followed PRISMA guidelines. We searched PubMed, Embase and Scopus to identify relevant studies assessing PJI among patients who received ALBC vs PBC. Studies were screened, selected, and assessed for risk of bias via appropriate checklists. Random effects meta-analyses were used to calculate risk ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was measured via the I² statistic. The effects of antibiotic type and dose were assessed via subgroup analysis.
Results: Eighteen studies with data from 72928 TKA (N=20201 for ALBC and N=52727 for PBC) were included. The overall analysis revealed no significant difference in PJI rates between the ALBC and PBC groups (OR 0.92, 95% CI 0.67–1.27; p=0.6). However, cement loaded with vancomycin (P=0.04) or cefuroxime (P=0.01) significantly reduced the risk of PJI. In contrast, cement containing gentamicin (P=0.2) or tobramycin (P=0.6) did not have a similar protective effect. The dose of the antibiotic did not appear to impact the results.
Conclusions: ALBC formulations containing vancomycin or cefuroxime were associated with a significant reduction in PJI risk, underscoring the potential of selective antibiotic use in cement.
Level of Evidence: Level 2
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