Use of antibiotic-loaded bone cement in knee prosthesis: infection prevention and its economic impact on hospitalization cost

Abstract

Background Periprosthetic joint infection (PJI) remains one of the most serious complications following total knee arthroplasty (TKA), often requiring complex surgical revisions and prolonged antibiotic therapy. Antibiotic-loaded bone cement (ALBC) has been proposed as a preventive strategy by delivering high local concentrations of antibiotics at the implant site. Objective This review aims to critically analyze the clinical effectiveness of ALBC in preventing PJIs in TKA and to evaluate its impact on healthcare costs associated with infection-related hospitalizations and revisions. Methods

A narrative review was conducted based on 22 peer- reviewed studies, including randomized trials, registry data,

systematic reviews, and economic analyses. The selected literature focused on infection rates, resistance patterns, biomechanical performance, and cost-effectiveness of ALBC compared to plain bone cement (PBC) in primary and revision TKA.

Results Evidence supports the selective use of ALBC in high-risk patients and revision procedures, showing reduced infection rates and favorable economic outcomes. However, its universal application in primary TKA remains controversial due to inconsistent findings and concerns regarding

mechanical properties and antibiotic resistance. Dual- antibiotic formulations demonstrate enhanced antimicrobial

efficacy, especially in biofilm-related infections. The mechanical performance of ALBC is preserved in low-dose industrial formulations, and cost analyses suggest long-term savings when used in targeted populations. Conclusion ALBC is a valuable adjunct in TKA for infection prevention, particularly in high-risk or revision cases. Its routine use in all primary procedures is not currently supported by conclusive evidence. Risk-based implementation, guided by microbiological and economic considerations, is recommended to optimize outcomes and ensure cost-effective care.