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Morristown Medical Center Team Finds No Difference in Infection Rates, Significant Cost Savings Between Antibiotic-Loaded Bone Cement and Plain Cement in Retrospective Analysis

February 20, 2019

Study Presented at the National Meeting of the Orthopedic Research Society

FEBRUARY 20, 2019, Morristown, NJ – A study conducted by a team from the total joint and perioperative service at Atlantic Health System’s Morristown Medical Center found that there was no difference in infection rates between antibiotic-loaded bone cement (ALBC) vs. “plain” cement after primary total joint reconstruction/replacement.

For the past few decades, hospitals have opted to use ALBC over plain cement after primary total joint reconstruction/replacement because of its potential to decrease infection rates.

“As hospitals continue to find ways to improve both patient care and affordability in the wake of bundled payment models and changing payment methods, providers must reduce unnecessary costs in order to increase quality and improve efficiency—and this study proves that plain cement is as effective and more cost-effective than ALBC,” said James Wittig, MD, our Chairman, Orthopedic Surgery and Medical Director of Orthopedics, Orthopedic Oncology and Sarcoma Surgery, Atlantic Health System, who presented the study at the National Meeting of the Orthopedic Research Society.

Dr. Wittig presents bone cement analysis


The team conducted a retrospective analysis of 4,116 hip or knee arthroplasty cases performed at Morristown Medical Center between 2016 and 2018. Of 3,968 knee cases, 3,442 received plain cement, and 526 received ALBC. Of 148 hip cases, 71 received plain cement, and 77 received ALBC.

A statistical analysis was performed using Fisher’s exact test and the National Healthcare Safety Network’s surgical site guidelines.

Cost Savings

In addition to no statistically significant difference in infection rates between the cements, the study found plain cement yields a significant cost saving.

In the retrospective analysis, the team found that a total of 989 bags of ALBC were used in 526 knee surgeries and 130 bags in 77 hip cases.

The cost for one bag of ABLC for hip and knee arthroplasty was $363.23 and $335.96 respectively. The cost for one bag of plain cement for hip and knee arthroplasty was $73.98 and $72.16, respectively, making the total cost of ALBC in knee arthroplasty $332,264.44 and hip arthroplasty was $47,219.90.

The team’s analysis found that using plain cement at all indexed procedures would have resulted in a total savings of $298,500.70.


“Our study demonstrates that routine use of antibiotic cement for primary joint replacements is not associated with a lower infection rate compared to use of plain cement, which is much more cost effective,” said Wittig.

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About Orthopedics at Atlantic Health System

Atlantic Health System’s Orthopedic program offers residents of New Jersey and the surrounding areas access to high-quality multidisciplinary treatments that span pre-surgical education through post-operative rehabilitation. With the latest diagnostic technologies and robotic equipment, many of our board-certified surgeons are experts in minimally invasive techniques that result in faster recoveries, greater range of motion, and smaller scars.

Each year, the Atlantic Orthopedic Institute performs more than 4,000 joint replacements and treats more than 1,400 traumatic orthopedic injuries, and US News and World Report recognized Morristown Medical Center as a high-performing hospital orthopedics in 2018.

Orthopedists at Morristown Medical Center provide assistance caring for patients with complex fractures of the pelvis and upper and lower extremities. For complex sports injuries, Atlantic Sports Health has highly-trained physicians who are experts at diagnosing and treating orthopedic and sports medicine problems and are active participants in academic and research programs. The Orthopedic Oncology program performs limb-sparing surgeries for patients with bone tumors or sarcomas.

For children with orthopaedic needs, orthopedists collaborate with pediatricians from Goryeb Children’s Hospital in all aspects of care, including state-of-the-art diagnostics, surgical treatment and assistive technology.

Atlantic Health System Orthopedics is nationally recognized for its expertise, earning numerous awards and accreditations for its services. Learn more >

About Atlantic Health System

Atlantic Health System is at the forefront of medicine, setting standards for quality health care in New Jersey, Pennsylvania and the New York metropolitan area. Powered by a workforce of more than 16,800 team members and 4,800 affiliated physicians dedicated to building healthier communities, Atlantic Health System serves more than half of the state of New Jersey including 11 counties and 4.9 million people. The system offers more than 400 sites of care, including six hospitals: Morristown Medical Center in Morristown, NJ, Overlook Medical Center in Summit, NJ, Newton Medical Center in Newton NJ, Chilton Medical Center in Pompton Plains, NJ, Hackettstown Medical Center in Hackettstown, NJ and Goryeb Children’s Hospital in Morristown, NJ.

In addition to the employed workforce, Atlantic Alliance, a Clinically Integrated Network represents more than 2,500 health care providers throughout northern and central NJ. This network includes 1,000 physicians and providers comprising one of the largest multi-specialty practices in New Jersey - Atlantic Medical Group, as well as members of the Atlantic Accountable Care Organization and Optimus Healthcare Partners which work to enhance patient care delivery.

Atlantic Health System provides care for the full continuum of health care needs including 12 urgent care centers, Atlantic Rehabilitation and Atlantic Home Care and Hospice. Facilitating the connection between these services on both land and air is the transportation fleet of Atlantic Mobile Health.

Atlantic Health System leads the Healthcare Transformation Consortium, a partnership of seven regional hospitals and health systems dedicated to improving access and affordability and is a founding member of the PIER Consortium – Partners in Innovation, Education, and Research – a streamlined clinical trial system that will expand access to groundbreaking research across seven health systems in New Jersey.

Atlantic Health System has a medical school affiliation with Thomas Jefferson University and is home to the regional campus of the Sidney Kimmel Medical College at Morristown and Overlook Medical Centers and is the official health care partner of the New York Jets.