Application of antibiotic-loaded bone cement in unicompartmental knee arthroplasty: inhibiting IL-6 levels and reducing postoperative infection rate

Objective: We aim to clarify the inhibitory effect of antibiotic-loaded bone cement (ALBC) on inflammatory factors, and its preventive effect on postoperative infections in unicompartmental knee arthroplasty (UKA). Methods: This prospective randomized controlled trial enrolled 104 osteoarthritis patients undergoing UKA, randomly assigned to the non-ALBC group (n = 52, bone cement without antibiotics) and ALBC group (ALBC with 1.0 g vancomycin hydrochloride, n = 52). Primary outcomes were postoperative inflammatory markers (CRP, ESR, TNF-α, IL-6); secondary outcomes included infection rate and HSS score. Independent-samples t-tests were used for continuous variables, χ2 test for categorical variables (infection rate, efficacy), and repeated measures analysis of variance for intra-group longitudinal comparisons. Results: The ALBC group demonstrated lower inflammatory markers at postoperative day 7 and at 3 months [CRP (3.52 ± 0.81 vs 6.92 ± 1.17, Cohen’s d = 3.379), ESR (16.29 ± 2.31 vs 20.19 ± 4.05, Cohen’s d = 1.183), TNF-α (29.71 ± 4.03 vs 36.25 ± 5.17, Cohen’s d = 1.411), and IL-6 (17.05 ± 3.72 vs 22.05 ± 4.38, Cohen’s d = 1.230)] (all p < 0.001), and also showed superior clinical outcomes, with lower postoperative infection rate (p = 0.016), higher HSS score (p < 0.001), and better overall clinical efficacy (p = 0.010) than the non-ALBC group. Conclusion: The application of ALBC in UKA was associated with reduced postoperative inflammatory markers such as IL-6 and a lower incidence of postoperative infection. These findings suggest that ALBC may play a beneficial role in postoperative recovery and joint function rehabilitation.