Introduction

The place of antibiotic-loaded cement in the prevention of peri-prosthetic infection after total knee arthroplasty (TKA) as well as their therapeutic role in the proven infection are still under discussion. The objective of this study was to investigate the potential benefit of using a cement combining high-dose gentamicin and clindamycin (C+G) in comparison with a cement containing low-dose gentamicin only (G) in TKA exchanges for any cause, by analyzing the incidence of surgical site infections (SSI).

Material

Methods

All patients operated on for a period of two years for TKA exchange regardless of etiology were included and followed up prospectively. All implants were cemented with antibiotic-loaded cement. In the first cohort, G cement was used (166 procedures - 81 aseptic and 85 septic). In the second cohort, G+C cement was used (141 procedures - 55 aseptic and 86 septic). The ISO rate at one year's follow-up was analyzed and compared in the two groups taking into account aseptic or septic etiology.

Results

In group G, 27 ISOs were recorded (16%): 6 after aseptic change (7%) and 21 after septic change (25%); of the latter, 3 were considered as infectious failures and 17 as a new infection (1 unclassifiable file). In the G+C group, 18 SSIs were recorded (13%): 7 after aseptic change (13%) and 11 after septic change (13%); among the latter, 1 was considered as an infectious failure and 6 as a new infection (2 unclassifiable records).
There was no significant difference between the overall ISO rates of the two groups. There was no significant difference between the ISO rates of the two groups for aseptic cases. There was a significant decrease in the ISO rate for Group G+C for septic cases. No complications related to the use of G+C cement were observed. The additional cost related to the use of G+C cement was estimated at € 50,000 per year.

Discussion

The use of G+C cement allowed a significant decrease in the ISO rate in septic cases, without modifying that of aseptic cases.

Conclusion

The additional cost of using G+C cement in TKA exchange for periprosthetic infection appears to be compensated by its higher efficiency on the ISO rate.