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

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.