Antibiotic bone cements: their use in routine primary total joint arthroplasty is justified

The use of antibiotic bone cement in total hip arthroplasty (THA) is the standard of care in countries with long-standing national registries, as data from the registries demonstrates an improvement in survivorship by reducing the incidence of both septic and aseptic failures. There is reluctance in North America to embrace antibiotic bone cement, although the percentage of use is increasing. Reasons cited for not using antibiotic cement include lack of efficacy, adverse effects on mechanical properties, increased costs, bacterial resistance, and systemic toxicity. Little to no compelling data in the literature support these claims, and significant evidence refutes them, specifically: registry data and randomized controlled trials demonstrate a clear reduction in deep joint infections with the use of antibiotic bone cement; antibiotic bone cement has lower incidence of both septic and aseptic loosening, indicating no negative effect on mechanical properties; antibiotic bone cement is cost-effective, given its proven ability to reduce revision rates and prevent poor patient outcomes; there is no evidence to support bacterial resistance, and antibiotic bone cement may reduce the incidence of resistance; and there are no reported cases of systemic toxicity from manufacturer-prepared antibiotic cement in primary THA or total knee arthroplasty. Based on the strong evidence supporting the benefits of antibiotic bone cement and the lack of evidence against its use, it is difficult to justify why antibiotic cement is not the standard of care for primary cemented THA in North America.