Prophylactic use of antibiotic bone cement: an emerging standard--in opposition.

Antibiotic-loaded bone cement (ABLC) is an effective delivery method of local antibiotics. ABLC for treatment should be high dose (>3.6 g per 40 g cement) for beads or spacers and 1 to 2 g antibiotic per 40 g cement for prosthesis fixation. Multiple antibiotics are required for treatment, with antibiotics being individualized according to culture susceptibilities. This approach requires hand mixing because there are no commercial high-dose products. ABLC should be low dose (< or =1 g per 40 g cement) for prophylaxis purposes. Concerns with toxicity and cement mechanical properties are inconsequential with low-dose ABLC. Available clinical evidence supports low-dose ABLC for prophylaxis in revisions and high-risk primary joints, but concerns of emerging drug-resistant organisms probably outweigh routine use of low-dose ABLC in all uncomplicated primary arthroplasties.