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My husband is carefully examining the bill for the total knee replacement I had earlier this month. He's noticing that the surgeon ordered intravenous antibiotics to prevent infection. We knew about this ahead of time. But there's also a charge for the cement that was used because it had antibiotic mixed in with it. If I was on antibiotics already, why was this extra step needed?

Infection is one reason why total knee replacements fail or have to be replaced themselves. Surgeons do everything they can to keep this from happening. Experts advise surgeons to take every preventive measure possible. To accomplish this, the patient should be given intravenous (IV) antiobiotic treatment and antibiotic impregnated cement when the implant is glued in place. These two measures together may help prevent septic failure of the first joint replacement. If infection does occur, the same two preventive steps must be taken when performing a revision surgery. Studies show that results are significantly better when both preventive steps are taken. There was a time when surgeons thought that just using the cement with antibiotic in it was enough. There was some evidence that the initial burst of antibiotics released coated the implant with a protective biofilm. Postoperative infections were reduced but not as much as when intravenous antibiotics were combined with the special cement. The results are especially dramatic when used in patients who have other health issues that put them at increased risk for infection such as diabetes or heart disease. The cost of the added step is likely pennies compared to the cost of a revision (second) surgery to remove and replace an infected joint replacement.

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