Do Antibiotic-Impregnated Intramedullary Dowels Assist in Eradicating Infection in Total Knee Arthroplasty?

Antibiotic-impregnated intramedullary dowels historically have been advocated and are frequently used to facilitate periprosthetic knee infection eradication. They are used for focused delivery of antibiotics into the femoral and tibial intramedullary canals during 2-stage resection utilizing an antibiotic cement spacer. However, the literature is limited on the use and efficacy of antibiotic-eluding intramedullary dowels in periprosthetic joint infection. We reviewed the available literature and have found that the data at this point are equivocal with respect to whether antibiotic-impregnated cement intramedullary dowels augment the intra-articular antibiotic cement spacer in eradicating infection in total knee arthroplasty. Thus, we believe that the decision to use dowels can be left up to the surgeon preference. However, further research is warranted to review operative room efficiency and healthcare costs, and to validate the clinical efficacy of antibiotic-impregnated dowels in periprosthetic joint infection.