Noncemented total knee arthroplasty with a local prophylactic anti-infection agent: a prospective series of 135 cases.

BACKGROUND I conducted a prospective study to assess the effectiveness of an absorbable calcium hydroxyapatite (Hac) layer mixed with vancomycin applied to the articular surface of prosthetic implants in preventing deep infections after noncemented total knee arthroplasty (TKA). This severe complication of TKA occurs in 2%-7% of cases. METHODS In all, 135 consecutive noncemented TKAs were performed in 126 patients, who were divided into 2 groups. Group 1 comprised 73 knees that received a noncemented implant without any local anti-infection treatment. Group 2 comprised 62 knees that received a noncemented implant with the local anti-infection agent, which consisted of a pasty mixture of 2 g absorbable Hac and 1-2 g vanco mycin. The paste was spread in a thin layer on the articular surface of the implants. Patients in both groups received systemic antibiotic therapy. RESULTS In group 1 (no local anti-infection agent), there were 3 deep infections (4.1%) in the early (< 2 mo) or intermediate (2 mo to 2 yr) period after surgery, but no signs of loosening. The infections were treated by arthroscopic debridement and antibiotic therapy. There were no infections or loosening of joints in group 2. CONCLUSION This study shows that a local anti-infection treatment is an effective supplement to systemic antibiotic therapy for the prevention of deep infections in noncemented TKA.