No Decreased Infection Rate When Using Antibiotic-Impregnated Cement in Primary Total Joint Arthroplasty

Zeng, Yi; Shen, Bin; Yang, Jing; Zhou, Zongke; Kang, Pengde; Pei, Fuxing

doi:10.3928/01477447-20141124-07

Cited by 17 publications

(11 citation statements)

References 32 publications

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“…TKA: Two meta-analyses [68, 69] concluded that the use of ALBC does not decrease the rate of deep or superficial infections compared to plain bone cement. One meta-analysis [70], including both TKA and THA surgeries, found a significantly lower risk of deep infections and no effect on the risk of superficial infections when ALBC was used.…”

Section: Resultsmentioning

confidence: 99%

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Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries

et al. 2017

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BackgroundLack of evidence contributes to unnecessary variation in treatment costs and outcomes. This study aimed to identify from interventions historically used for total knee or hip arthroplasty (TKA, THA): i) if routine use is supported by high-level evidence; ii) whether surgeon use aligns with the evidence.MethodsPart 1: Systematic search of electronic library databases for systematic reviews and practice guidelines concerning seven acute-care interventions. Intervention-specific recommendations concerning routine use were extracted by assessors. Part 2: Prospective medical record audit of the acute-care received by 1900 patients involving 120 orthopaedic surgeons. Surgeon use per intervention was summarized using caterpillar plots. Surgeon-specific routine and non-routine use was defined as use in ≥ 90% and ≤ 10% of patients, respectively. Primary analysis included only surgeons contributing ≥ 10 patients.ResultsContinuous passive motion (TKA): Routine use not recommended; 85.7% of surgeons did not use it routinely. Tranexamic Acid: Routine use recommended; 26.9% of surgeons used it routinely. Cryotherapy: Routine use not recommended; 45.7% of surgeons used it routinely for TKA; 31.8% used it routinely for THA. Intra-articular drainage: Routine use not recommended for TKA, but possible benefits for THA; 5.7% of surgeons used it routinely for TKA, 0.0% used it routinely for THA. Antibiotic loaded bone cement: Routine use for TKA not supported, recommendations for use for THA are inconsistent; 90.0% of surgeons used it routinely for TKA, 100.0% used it routinely for THA. Patella resurfacing (TKA): No recommendation could be made; 57.1% of surgeons routinely resurfaced the patella. Indwelling urinary catheterisation: Routine use recommended; 59.6% of surgeons used it routinely.ConclusionRecommendations for routine use or not exist for some of the acute-care interventions examined. Surgeon practices vary widely even in the presence of high-level recommendations. It is unclear whether further evidence alone would lessen unwarranted practice variation.

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Section: Resultsmentioning

confidence: 99%

“…THA: One meta-analysis concluded that ALBC did not lower the rate of deep or superficial infection rate [69]. As described above, another meta-analysis concluded ALBC reduced the rate of deep infection in THA, but not TKA surgeries [70].…”

Section: Resultsmentioning

confidence: 99%

Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries

et al. 2017

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“…ALBC has been in use since first being developed in 1970 as a potential method for in situ drug release [59] . Despite its widespread use, the antimicrobial efficacy of ALBC is debated [60,61] . Due to irregular release of antibiotic, only 5%-8% of the drug typically elutes properly [62] .…”

Section: Antibiotic-loaded Bone Cementmentioning

confidence: 99%

Antimicrobial technology in orthopedic and spinal implants

Eltorai

Haglin

Perera

et al. 2016

WJO

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Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines orthopedic implant antimicrobial technology, its current applications and supporting evidence, and clinically promising future directions.Key words: Antimicrobial; Coated implants; Antibiotic; Antiseptic; Nano-silver; Photoactive Core tip: Infections can hinder orthopedic implant function and retention. Current implant-based antimicrobial strategies largely utilize coating-based approaches in order to reduce biofilm formation and bacterial adhesion. Several emerging antimicrobial technologies that integrate a multidisciplinary combination of drug delivery systems, material science, immunology, and polymer chemistry are in development and early clinical use. This review outlines the latest orthopedic implant antimicrobial technologies-including updates on chitosan

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“…And from this point of view, lower overall infection rate might make it hard to reach statistical significance in the present study even though 1,138 cases had been recruited. Similarly, other reports which could not find significant difference with or without ALBC showed lower occurrence rate of deep infection, specifically, lower than 1.5% in the report by McQueen, et al [11], Hinarejos, et al [12], and Zeng, et al [20].…”

Section: Discussionmentioning

confidence: 61%

Efficacy of Adjunctive Antibiotic-Loaded Acrylic Bone Cement for Deep Surgical Site Infection Prophylaxis after Primary Cemented Hip and Knee Arthroplasties

Fumio¹,

Oha²,

Kanayama³

et al. 2017

J Orthop Surg Tech

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Purpose: The efficacy of antibiotic-loaded acrylic bone cements (ALBC) for prophylaxis of deep surgical site infections (deep SSIs) after primary cemented joint replacement surgery remains controversial. Therefore, the purpose of this study was to examine the issue, with respect to three types of arthroplasty, namely, total knee arthroplasty (TKA), total hip arthroplasty (THA), and bipolar hip arthroplasty (BHA). Methods:The records of 1,138 patients who received primary cemented TKAs, THAs, and BHAs between January 2006 and May 2013 were retrospectively reviewed. ALBC was used in 558 cases (ALBC group), and non-antibiotic-loaded acrylic bone cement was used in 580 cases (non-ALBC group). A logistic regression analysis was performed to determine the influence of ALBC on the incidence of SSI and to determine the risk factors associated with SSI. Results:The overall rate of deep SSI was 0.97% (1.4% in the ALBC group and 0.5% in the non-ALBC group), with the difference not being significant. Results of multivariate logistic regression analysis with the stepwise selection method showed that diabetes mellitus was one of the risk factors associated with the incidence of deep SSI after surgery. Conclusions:In the study population, ALBC did not prevent deep SSIs in primary cemented joint replacement, regardless of the type of joint replacement and whether or not the patient was diabetic.

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No Decreased Infection Rate When Using Antibiotic-Impregnated Cement in Primary Total Joint Arthroplasty

Cited by 17 publications

References 32 publications

Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries

Evidence base and practice variation in acute care processes for knee and hip arthroplasty surgeries

Antimicrobial technology in orthopedic and spinal implants

Efficacy of Adjunctive Antibiotic-Loaded Acrylic Bone Cement for Deep Surgical Site Infection Prophylaxis after Primary Cemented Hip and Knee Arthroplasties

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