The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement

Gutowski, Christina J.; Zmistowski, Benjamin; Clyde, Corey T.; Parvızı, Javad

doi:10.1302/0301-620x.96b1.31428

Cited by 68 publications

(51 citation statements)

References 20 publications

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“…Clinical studies have shown that antibiotic-loaded bone cement can decrease deep infection rates of cemented total hip arthroplasties and revision rates due to suspected “aseptic” loosening when combined with systemic antibiotic administration 34. This solution has proven both effective and economically sound, especially in high-risk patients 35, 36. However, because PMMA was not designed as a local delivery carrier of antibiotics it may have some limitations.…”

Section: Discussionmentioning

confidence: 99%

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Cl¹,

Malizos

Capuano³

et al. 2016

J. Bone Joint Infect.

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Background: Infection remains among the main reasons for joint prosthesis failure. Preclinical reports have suggested that antibacterial coatings of implants may prevent bacterial adhesion and biofilm formation. This study presents the results of the first clinical trial on an antibiotic-loaded fast-resorbable hydrogel coating (Defensive Antibacterial Coating, DAC®) in patients undergoing hip or knee prosthesis.Methods: In this multicenter, randomized prospective study, a total of 380 patients, scheduled to undergo primary (n=270) or revision (n=110) total hip (N=298) or knee (N=82) joint replacement with a cementless or a hybrid implant, were randomly assigned, in six European orthopedic centers, to receive an implant either with the antibiotic-loaded DAC coating (treatment group) or without coating (control group). Pre- and postoperative assessment of clinical scores, wound healing, laboratory tests, and x-ray exams were performed at fixed time intervals.Results: Overall, 373 patients were available at a mean follow-up of 14.5 ± 5.5 months (range 6 to 24). On average, wound healing, laboratory and radiographic findings showed no significant difference between the two groups. Eleven early surgical site infections were observed in the control group and only one in the treatment group (6% vs. 0.6%; p=0.003). No local or systemic side effects related to the DAC hydrogel coating were observed, and no detectable interference with implant osteointegration was noted.Conclusions: The use of a fast-resorbable, antibiotic-loaded hydrogel implant coating can reduce the rate of early surgical site infections, without any detectable adverse events or side effects after hip or knee joint replacement with a cementless or hybrid implant.

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Section: Discussionmentioning

confidence: 99%

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Cl¹,

Malizos

Capuano³

et al. 2016

J. Bone Joint Infect.

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“…This route of administration was first described by Buchholz and Engelbrecht. However, its role in infection prevention, and, therefore, the use of these systems in clinical practice, has proved controversial because of the uncertainty about the development of possible antibiotic resistance after prolonged exposure time, their effectiveness, the cost of these systems, toxicity, and loosening of mechanical properties . These aspects are reviewed in this document (Fig.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic‐loaded Bone Cement as Prophylaxis in Total Joint Replacement

Martínez-Moreno

Merino

Nácher

et al. 2017

Orthopaedic Surgery

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One of its most serious complications associated with arthroplasty is the development of infections. Although its prevalence is only between 0.5% and 3%, in some cases it can lead to death. Therefore, an important challenge in joint surgery is the prevention of infections when an arthroplasty is performed. The use of antibiotic-loaded cements could be a suitable tool due to numerous advantages. The main advantage of the use of antibiotic loading into bone cement derives directly from antibiotic release in the effect site, allowing achievement of high concentrations at the site of action, and minimal or no systemic toxicity. This route of administration was first described by Buchholz and Engelbrecht. In the case of infection treatment, this is an established method and its good results have been confirmed. However, its role in infection prevention, and, therefore, the use of these systems in clinical practice, has proved controversial because of the uncertainty about the development of possible antibiotic resistance after prolonged exposure time, their effectiveness, the cost of the systems, toxicity and loosening of mechanical properties. This review discusses all these topics, focusing on effectiveness and safety, antibiotic decisions, cement type, mixing method, release kinetics and future perspectives. The final objective is to provide the orthopaedic surgeons the right information in their clinical practice based on current evidence.

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“…Nowadays, low-dose antibiotic-impregnated bone cement (1 g antibiotic(s) in 40 g PMMA) is used as prophylaxis in orthopedic surgery. However, cements with higher content of antibiotics (usually 4 g antibiotics/40 g PMMA) are recommended in the treatment of orthopedic infections [3][4][5] . Many antibiotics including ciprofloxacin and vancomycin are widely used in this field.…”

mentioning

confidence: 99%

Evaluation of the Effect of Ciprofloxacin and Vancomycin on Mechanical Properties of PMMA Cement; a Preliminary Study on Molecular Weight

Gandomkarzadeh

Moghimi

Mahboubi

2020

Sci Rep

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Antibiotic-loaded bone cement (ALBC) is commonly used in joint replacement therapy for prevention and treatment of bone infection and mechanical properties of the cement is still an important issue.The effects of ciprofloxacin and vancomycin was investigated on mechanical characterization of PMMA bone cement. Different properties of cement containing (0, 2.5, 5 and 10% W/W) antibiotics, including compressive and bending properties, microstructural, porosity and density were evaluated. Both antibiotics significantly reduced the density values and mechanical properties (compressive and flexural strength and modulus) in all groups in comparison to control over first two weeks (p < 0.05). This reduction was due to increased porosity upon antibiotic addition (3.05 and 3.67% for ciprofloxacin and vancomycin, respectively) in comparison to control (2.08%) (p < 0.001) and exposure to aqueous medium. Vancomycin as antibiotic with higher molecular weight (MW = 1485) had significant effect on compressive strength reduction of the cement at high amount compared to ciprofloxacin (MW = 367) (P < 0.01), there was no difference between two antibiotics at lower concentrations (P > 0.05). The effect of antibiotic loading is both molecular weight and drug content dependent. The time is also an important parameter and the second week is the probably optimum time to study mechanical behavior of ALBC.

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The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement

Cited by 68 publications

References 20 publications

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Does an Antibiotic-Loaded Hydrogel Coating Reduce Early Post-Surgical Infection After Joint Arthroplasty?

Antibiotic‐loaded Bone Cement as Prophylaxis in Total Joint Replacement

Evaluation of the Effect of Ciprofloxacin and Vancomycin on Mechanical Properties of PMMA Cement; a Preliminary Study on Molecular Weight

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