Effects of Antibiotic-Loaded Bone Cement on the Risk of Periprosthetic Joint Infection in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

内容摘要

The use of antibiotic-loaded bone cement (ALBC) is a common strategy for preventing periprosthetic joint infection (PJI) after total knee arthroplasty (TKA); however, its effectiveness remains controversial. This study aimed to provide a clear, evidence-based recommendation regarding the use of ALBC versus plain bone cement (PBC) for the prevention of PJI after TKA. This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 reporting guidelines. PubMed, Embase, and Scopus were searched to identify relevant studies evaluating PJI in patients who received ALBC versus PBC. Eligible studies were screened, selected, and assessed for risk of bias using appropriate checklists. Random-effects meta-analyses were performed to calculate odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. The effects of antibiotic type and dose were examined through subgroup analyses. Meta-regression was performed to evaluate the effects of age, sex, follow-up duration, and diabetes mellitus on the occurrence of PJI. Eighteen studies including 72,928 TKAs (20,201 in the ALBC group and 52,727 in the PBC group) were included. The overall analysis showed 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, cefuroxime-loaded cement was associated with a significantly lower risk of PJI (p = 0.01). In contrast, cement containing gentamicin (p = 0.08), vancomycin (p = 0.3), or tobramycin (p = 0.6) did not show a similar protective effect. Antibiotic dose, age, sex, diabetes mellitus, and follow-up duration did not appear to influence the results. Most ALBC formulations were not associated with a significant reduction in the risk of PJI. Larger, dedicated trials are needed to further evaluate the effect of ALBC on PJI risk in selected patient populations.