Systemic Antibiotics and Gentamicin-Containing Bone Cement in the Prophylaxis of Postoperative Infections in Total Hip Arthroplasty

Josefsson, G; Lindberg, Lars; Wiklander, B

doi:10.1097/00003086-198109000-00027

Cited by 131 publications

(48 citation statements)

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“…The higher infection rate using cemented fixation cannot easily be explained. The use of cement with antibiotics is reported to be associated with lower rates of infection in total hip arthroplasty 32,33 when compared with the use of cement without antibiotics, but why this should be different when compared with cementless implants is uncertain. Nevertheless, infection remains a major cause of failure in the present series and efforts to minimise its incidence should continue.…”

Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

Khaw

Kirk

Morris

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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We have carried out a long-term survival analysis of a prospective, randomised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements. A consecutive series of 501 replacements received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation.The patients were contacted at a mean follow-up of 7.4 years (2.7 to 13.0) to establish the rate of survival of the implant. The ten-year survival was compared using life-table and Cox's proportional hazard analysis.No patient was lost to follow-up. The survival at ten years was 95.3% (95% CI 90.3 to 97.8) and 95.6% (95% CI 89.5 to 98.2) in the cemented and cementless groups, respectively. The hazard ratio for failure in cemented compared with cementless prostheses was 0.97 (95% CI 0.36 to 2.6). A comparison of the clinical outcome at ten years in 80 knees showed no difference between the two groups.The survival of the press-fit condylar total knee replacement at ten years is good irrespective of the method of fixation and brings into question the use of more expensive cementless implants. J Bone Joint Surg [Br] 2002;84-B:658-66. Received 27 July 2001; Accepted 24 September 2001 As the demand for knee replacement surgery increases resources need to be allocated to implants with the best long-term clinical outcome and survival rates.Liow and Murray 1 reported that 54% of knee prostheses, which were available in the UK did not have functional or survival results published in peer-reviewed journals. In their report, there were only five implants (13%) with published survival analyses of ten years or more and only five (13%) for which a functional outcome at more than five years was available. This paucity of data concerning the long-term outcome after total knee replacement (TKR) is alarming considering the rapid rise in the number of different designs of prostheses which are available. There is considerable debate regarding the possible benefits of using cementless fixation in joint replacement surgery. These include preservation of bone stock, ease of revision, the avoidance of complications of cementation and lastly, but most importantly, improved long-term survival of the implant. Although it is now clear that aseptic loosening is mainly related to wear debris rather than to cemented fixation, the question remains as to whether cementless implants have an improved long-term survival. This can only be answered by a randomised trial comparing the two methods of fixation. For TKR no such reports have been published in peer-reviewed journals. Our aim therefore was to compare the long-term survival, in a prospective randomised trial, of cemented with cementless fixation, using the press-fit condylar TKR system.

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Section: Discussionmentioning

confidence: 99%

A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

Khaw

Kirk

Morris

et al. 2002

The Journal of Bone and Joint Surgery. British volume

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“…There is some evidence that gentamicin bone cement in combination with systemic antibiotics, reduces septic arthritis in hip replacement (Josefsson et al 1981, Trippel 1986, Lynch et al 1987. We therefore suggest its use in cemented knee and hip arthroplasty in all patients with rheumatoid arthritis, diabetes and previous operations.…”

Section: Discussionmentioning

confidence: 95%

Perioperative factors associated with septic arthritis after arthroplasty

Wymenga¹,

Horn²,

Theeuwes³

et al. 1992

Acta Orthopaedica Scandinavica

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“…[22][23][24] Other investigations have indicated that adding antibiotics to the cement gives better results than using plain cement only. [25][26][27] Two randomised trials have compared the effect of antibiotics in the bone cement with antibiotics given systemically, 13,[28][29][30] but the results were inconclusive, with no difference reported in the smallest study 30 and an improvement in the rate of deep infection in the hips with antibiotic-containing cement which was not statistically significant. 13 In both studies, superficial infections were more common among operations performed with antibiotic-containing cement and a concurrent use of systemic administration was suggested.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic Prophylaxis in Total Hip Arthroplasty

Espehaug

Engesæter

Vollset

et al. 1997

The Journal of Bone and Joint Surgery. British volume

132

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We have assessed the effect of different regimes of antibiotic prophylaxis on the survival of total hip implants, comparing antibiotics administered both systemically and in the bone cement, systemically only, in the bone cement only and with no antibiotics given.We studied 10 905 primary cemented total hip replacements, performed for osteoarthritis of the hip and reported to the Norwegian arthroplasty register between 1987 and 1995. Cox-estimated failure-rate ratios (FRR) are presented with adjustment for gender, age, the brand of cement, the prosthesis, the type of operating theatre and the operating time.For revisions performed for infection (39 operations), the lowest rate of revision was found among patients receiving antibiotic-containing cement plus systemic antibiotics (n = 5804). The revision rate for the 4586 patients receiving systemic antibiotics only was 4.3 times greater (95% CI 1.7 to 11.0, p = 0.001); in 239 with antibiotics in the bone cement only it was 6.3 times greater (CI 1.6 to 25.0, p = 0.003); and in the 276 who did not receive antibiotics it was by 11.5 times greater (CI 2.1 to 63.0, p = 0.002). Adjustment for the total amount of systemic antibiotic administered did not change the results. We also observed an increased revision rate for aseptic loosening (109 operations) comparing the systemic-only (FRR = 1.8, CI 1.1 to 2.9, p = 0.01) and the cement-only regimes (FRR = 2.6, CI 1.2 to 5.9, p = 0.02) with the combined dosage.Our findings show that systemic antibiotics combined with antibiotic-containing bone cement led to fewer revisions than the other methods.

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Systemic Antibiotics and Gentamicin-Containing Bone Cement in the Prophylaxis of Postoperative Infections in Total Hip Arthroplasty

Cited by 131 publications

References 0 publications

A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

A randomised, controlled trial of cemented versus cementless press-fit condylar total knee replacement

Perioperative factors associated with septic arthritis after arthroplasty

Antibiotic Prophylaxis in Total Hip Arthroplasty

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