CORR Insights^®: What is the Intraarticular Concentration of Tobramycin Using Low-dose Tobramycin Bone Cement in TKA: An In Vivo Analysis?

Excerpt

Infection following TKA is the most common cause for revision knee surgery in the United States [3] and the incidence is expected to rise steeply over the next 15 years [8]. Treatment of a patient with an infected TKA can generate considerable morbidity and cost [10]. One strategy to reduce the occurrence of periprosthtetic infections is to use antibiotic-laden bone cement (ALBC) at the time of primary TKA. This strategy remains controversial, as data from national registries, randomized clinical trials and meta-analyses suggest a protective effect of ALBC against infection when used in hips, but a variable effect in knees [1, 2, 4, 5, 9, 11]. It is not clear whether the inconsistent efficacy in TKA is related to the duration and quantity of locally elevated antibiotic levels in TKA as compared to that seen after THA. Although studies have looked at the elution of high-dose tobramycin from cement [6], as in revision TKA for infection, to my knowledge, there have been no studies specifically addressing the intraarticular concentration of commercially available tobramycin impregnated cement when used in primary TKA. The current utilization of tobramycin ABLC in primary TKA is based solely on the results of studies in THA. …