Guidelines for Complications of Cancer Treatment Vol VIII Part B

9. Saline irrigation of the wound contributes to a 12% to56% reduction of the wound bacterial counts, andprevents tissue desiccation 4,25 . The addition of antibioticsto the irrigation solutions remains controversial 51,52 , butmay be reasonable during orthopedic procedures 4 . Mostcommonly used is a triple antibiotic solution ofneomycin, polymyxin, and bacitracin, because itprovides the most complete coverage against commonmicroorganisms known to cause infection 51 . Morestudies are needed before routine implementation of thistechnique.10. There is insufficient evidence to support or refute theroutine use of closed surgical drainage in implantorthopedic surgery 53 . If used, drain removal should beaccomplished early to prevent retrograde contaminationof the wound 25 .Antibiotic-impregnated bone cementThe use of antibiotic-impregnated cement for primary andrevision joint arthroplasty is becoming the standard of practicein Europe and Scandinavia 54 . It has been approved by the Foodand Drug Administration in the United States for use only ininfected joint arthroplasty. There are no established guidelinesfor use of these agents for prophylaxis in the United States 9 ,although the antibiotic-impregnated bone cements have beenextensively studied.1. A large prospective multicenter randomized Swedishstudy (1688 consecutive total hip arthroplasties) founda statistically significant difference at 5-year follow-upbetween deep infection rates in patients treated withsystemic antibiotics (1.9%) compared with patients whohad gentamicin-impregnated cement (0.8%). At 10-yearfollow-up the difference between the two groups (1.6%versus 1.1%) was not significant 55 .132