Antibiotic Bone Cements: Their Use in Routine Primary Total Joint Arthroplasty is Justified
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".