Background: A prospective, randomized study was conducted to evaluate the efficacy of cefuroxime-impregnated cement in the prevention of deep infection after primary total knee arthroplasties performed without so-called clean-air measures, such as laminar flow and body-exhaust suits.

Methods: Three hundred and forty primary total knee arthroplasties were performed with cementless fixation of the femoral component and cement fixation of the patellar and tibial components. The knees were randomly divided into two groups. In Group 1 (178 knees), cefuroxime-impregnated cement was used for fixation, whereas in Group 2 (162 knees), the cement did not contain cefuroxime. There was no significant difference between the two groups regarding demographic variables, the preoperative or postoperative knee score, the duration of the operation or of the use of the tourniquet, or the amount of blood transfused perioperatively. The average duration of follow-up was forty-nine months (range, twenty-six to eighty months).

Results: No deep infection developed in the 178 knees in Group 1, whereas a deep infection developed in five (3.1%) of the 162 knees in Group 2 (p = 0.0238). Two superficial wound infections developed in each group.

Conclusions: Cefuroxime-impregnated cement was shown to be effective in the prevention of early to intermediate deep infection after primary total knee arthroplasty performed with use of perioperative systemic antibiotic prophylaxis but no so-called clean-air measures.