Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox.

BACKGROUND: The use of antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic infection (PPI) after total hip (THA) and knee arthroplasty (TKA). However, the economic benefit of using ALBC routinely remains controversial. METHODS: A total of 2518 patients subjected to THA, partial hip arthroplasty, and TKA between 2009 and 2012 were identified in our prospectively collected registry. Two groups were defined: before (2009-2010) and after the introduction of ALBC (2011-2012). The risks of PPI associated with each type of surgery in each group were determined and compared. Patients subjected to THA without cemented implants were used as controls, and possible bias associated with changes in infection rate during the study period and other variables were controlled. The costs of the use of ALBC were calculated, along with the savings per case of PPI avoided. The minimum follow-up for discarding PPI was 2 years. RESULTS: Following the introduction of ALBC, a global decrease of 57% was observed in the risk of PPI (P = .001). By type of surgery, the decrease was 60.6% in the case of TKA (P = .019) and 72.6% in the case of cemented hip arthroplasty (partial and total; P = .009). No decrease in infection rate was noted in uncemented hip arthroplasty (P = .42). The total saving associated with the use of ALBC was €1,123,846 (€992 per patient): €440,412 after TKA (€801 per patient) and €686,644 after cemented hip arthroplasty (€2672 per patient). CONCLUSION: The use of ALBC has been found to be effective in preventing PPI after TKA and hip arthroplasty, with a favorable cost-efficiency profile using standardized cost and infection rates in our setting.