Limited evidence does not support the routine use of antibiotics in the cement for primary total knee arthroplasty (TKA).

Rationale
Two moderate quality studies and one low quality registry review were considered.  One moderate quality randomized study demonstrated a reduction in total knee arthroplasty infection in diabetic patients from 13.5 % to 0% when cefuroxime was added to the cement.  This study was performed in operating rooms without modern features (Chiu 2001).  One moderate quality, randomized, prospective study demonstrated a reduction in revision total knee arthroplasty infection rates when vancomycin was added to the cement (Chiu 2009).  A large Canadian registry study reviewing more than 36000 patients found no difference in revision rates for infection between those patients treated with or without antibiotics in the cement. Given two moderate quality studies that are not widely applicable to patients with osteoarthritis undergoing primary total knee arthroplasty and one low quality, although large, registry review demonstrating no benefit from routinely adding antibiotics to cement for primary total knee arthroplasty, it is the conclusion of the work group that limited evidence does not support the routine use of antibiotics in the cement for primary total knee arthroplasty. One study did provide some suggestion that antibiotics added to the cement may be of benefit in diabetic patients. (Chiu 2001).

Of note, the FDA approved indications for antibiotic loaded cement in total knee arthroplasty are limited to revision scenarios and do not include primary applications (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpcd/classification.cfm?id=mbb).
 
  1. Chiu,F.Y., Lin,C.F. Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees. J Bone Joint Surg Am 2009/3/1; 3: 628-633
  2. Chiu,F.Y., Lin,C.F., Chen,C.M., Lo,W.H., Chaung,T.Y. Cefuroxime-impregnated cement at primary total knee arthroplasty in diabetes mellitus. A prospective, randomised study. J Bone Joint Surg Br 2001/7; 5: 691-695