Antibiotic-loaded acrylic cement: current concepts

Antibiotic-loaded acrylic cement has been used routinely since 1972 at the authors' hospitals, where a series of some 22,000 joint arthroplasty operations was performed from 1964-1983. The current status of the material is presented with up-to-date follow-up statistics on prophylactic therapy and on established deep infections. The results of 869 exchange arthroplasties are compared with results published in 1981. In the future, results will be presented in the form of survival curves. The method by which survival tables and curves are constructed is critical. Investigators should use survival curves for ease of comparison and because of the wide range of possibilities in an analysis of covariable factors. A retrospective actuarial analysis was made of 825 one-stage reimplantations in which antibiotic-loaded acrylic cement was used for infected total hip arthroplasties. Staphylococcus aureus was the most commonly encountered organism. Failure rates of prostheses infected by S. aureus, S. species, and anaerobic corynebacteria did not differ statistically. A factor that significantly contributed to failure of this method of treatment was Pseudomonas infection. By actuarial analysis five years after operation, a success (survival) rate of 77% was calculated.