Antibiotic-loaded bone cement is associated with a lower risk of revision following primary cemented total knee arthroplasty

Abstract

Aims Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. Materials and Methods Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. Results Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. Conclusion After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331–1347.

Antibiotic loaded β-tricalcium phosphate/calcium sulfate for antimicrobial potency, prevention and killing efficacy of Pseudomonas aeruginosa and Staphylococcus aureus biofilms

“…Previous studies have indicated that local use of ALBC is effective in preventing both PJI [14][15][16][17] and FRI [18][19][20][21] following joint arthroplasty and open fracture surgery, respectively. After analyzing the prophylactic effect of ALBC against infection in primary cemented TKA of 731,214 cases, Jameson et al 16 concluded that ALBC was associated with a lower risk of revisions for infections (hazard ratio 0.84, 95% CI 0.67-1.01). As for FRI, a recent systematic review 22 summarized the effect of local antibiotic prophylaxis when treating open limb fractures.…”

Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial

“…With an estimated annual cost of US $8659 per patient, diabetes foot care poses an increasing socioeconomic burden for the public health [49]. The cost-effectiveness analyses of ALBC have mostly been done in the knee, hip, and shoulder arthroplasty studies [50][51][52][53][54]. Moreover, in order to achieve the standardization of ALBC use, these studies have investigated factors such as cement/antibiotic mix models [50], quantity of antibiotics loaded [50,51], and nature of bone cement [52][53][54].…”

Antibiotics and cement: what I need to know?

“…Based on these data it was concluded that 8.7 revisions per 1000 TKRs could be avoided at 10 years, if ALBC is used for all primary TKA. 12 The results from a recently conducted quasi-randomized clinical trial with 848 intracapsular neck fracture patients in the UK have added further evidence to which extent a high dose double antibiotic-loaded bone cement is able to reduce the infection risk in high risk patients. If the bone cement Copal G+C (Hereaus Medical, Yardley, PA, USA) (high dose antibiotic content: 1 g gentamicin and 1 g of clindamycin in 40 g of cement powder) was used for cemented hemi-arthroplasty instead of the low dose cement PALACOS R+G (low dose antibiotic cement: 0.5 gentamicin in 40 g of cement powder), the incidence rate of superficial and deep infections was drastically reduced from 5.3% to 1.7%.…”