The most common additive to the cement mixture is an antibiotic. In the setting of the primary total knee, antibiotics are not usually added to the cement. The addition is more common in the revision total knee replacement or after a previous infection. Although the properties of the cement do change with this addition, the fatigue properties are not changed at all. Askew showed that the porosity of the tobramycin-cement complex was doubled; however, there were no significant differences in bending strength of any of the specimens. 26 If the antibiotic is added in the powder form, the cement properties are only slightly changed. Addition in the liquid form has greater effect and is not recommended. When antibiotics are added, each individual cement leaches the drug out to the surrounding soft tissues at a different rate partially related to the particle size of the powder that is used. Thus, it is again critical that the surgeon understands the properties of the specific cement that he is using.
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