Impact of Antibiotic Bone Cement on Infection Rates in Primary Total Knee Arthroplasty: A Grade-Assessed Systematic Review and Meta-Analysis of Observational Studies Involving Over 4 Million Patients Publisher

Summary: Does antibiotic bone cement prevent knee implant infection? A meta-analysis found no significant reduction in infections after primary knee replacement; evidence uncertain. #Orthopedics #Infection

Majdi A ; Amiri S ; Kafiabadi M J ; Ghanbari A ; Talebi S ; Jalalpour P
Source: Open Forum Infectious Diseases Published:2026

Abstract

This systematic review and meta-analysis aimed to evaluate the impact of antibiotic-loaded bone cement (ALBC) on infection rates in primary total knee arthroplasty (TKA). A systematic search was conducted. The primary outcome was PJI incidence. Pooled effect estimates were calculated using hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs). Twenty-one studies involving over 4 million patients were included. The pooled analysis showed no significant association between ALBC use and PJI reduction (HR, 1.04; 95% CI, 0.91–1.19; P = .56) with substantial heterogeneity (I2 = 81.6%), likely due to variations in study design and risk of bias. Sensitivity analyses confirmed the robustness of the findings. This study, with very low certainty of evidence, found no significant reduction in PJI rates with ALBC in primary TKA. © The Author(s) 2026. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.