A1 Refereed original research article in a scientific journal
Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement
Authors: Leta, Tesfaye H.; Lie, Stein Atle; Fenstad, Anne Marie; Lygre, Stein Håkon L.; Lindberg-Larsen, Martin; Pedersen, Alma B.; W-Dahl, Annette; Rolfson, Ola; Bülow, Erik; van Steenbergen, Liza N.; Nelissen, Rob G. H. H.; Harries, Dylan; de Steiger, Richard; Lutro, Olav; Mäkelä, Keijo; Venäläinen, Mikko S.; Willis, Jinny; Wyatt, Michael; Frampton, Chris; Grimberg, Alexander; Steinbrück, Arnd; Wu, Yinan; Armaroli, Cristiana; Gentilini, Maria Adalgisa; Picus, Roberto; Bonetti, Mirko; Dragosloveanu, Serban; Vorovenci, Andreea E.; Dragomirescu, Dan; Dale, Håvard; Brand, Christian; Christen, Bernhard; Shapiro, Joanne; Wilkinson, J. Mark; Armstrong, Richard; Wooster, Kate; Hallan, Geir; Gjertsen, Jan-Erik; Chang, Richard N.; Prentice, Heather A.; Sedrakyan, Art; Paxton, Elizabeth W.; Furnes, Ove
Publisher: JAMA Network
Publication year: 2024
Journal: JAMA Network Open
Journal name in source: JAMA network open
Journal acronym: JAMA Netw Open
Article number: e2412898
Volume: 7
Issue: 5
eISSN: 2574-3805
DOI: https://doi.org/10.1001/jamanetworkopen.2024.12898
Web address : https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819041
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/454722071
Importance: Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient.
Objective: To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement.
Design, setting, and participants: This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023.
Exposure: Primary TKA with ALBC vs plain bone cement.
Main outcomes and measures: The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 - Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes.
Results: Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement.
Conclusions and relevance: In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.
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Funding information in the publication:
Dr Leta reported receiving grants from Western Norway Health Authority during the conduct of the study. Dr Rolfson reported personal fees from LINK Sweden Educational and research consultancy, ZimmerBiomet, grants from Pfizer, research funding from Johnson & Johnson (paid to institution), and serving as Director of the Swedish Arthroplasty Register and immediate past president of the International Society of Arthroplasty Registries outside the submitted work. Dr Venäläinen reported receiving grants from State Research Funding of the Well-being Services County of Southwest Finland during the conduct of the study. Dr Christen reported member of the advisory board of the Swiss National Joint Registry, Hip and Knee, outside the submitted work. Dr Hallan reported receiving personal fees from Ortomedic, Link Norway, and Heraeus Medical. Dr Gjertsen reported receiving personal fees from LINK Norway, Ortomedic (DePutSynthes), Heraeus Medical, and Smith & Nephew outside the submitted work. Dr Furnes reported receiving
