A1 Refereed original research article in a scientific journal
Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients
Authors: Leta, Tesfaye H.; Chang, Richard N.; Lie, Stein Atle; Fenstad, Anne Marie; Lygre, Stein Håkon L.; Lindberg-Larsen, Martin; Pedersen, Alma B.; W-Dahl, Annette; Rolfson, Ola; Johansson, Oskar; van Steenbergen, Liza N.; Nelissen, Rob; Harries, Dylan; Holder, Carl; Lewis, Peter; de Steiger, Richard; Lutro, Olav; Mäkelä, Keijo; Venäläinen, Mikko S.; Willis, Jinny; Frampton, Chris; Wyatt, Michael; Grimberg, Alexander; Steinbrück, Arnd; Wu, Yinan; Dale, Håvard; Brand, Christian; Christen, Bernhard; Shapiro, Joanne; Wilkinson, J. Mark; Edwards, Morgan; Hallan, Geir; Gjertsen, Jan-Erik; Furnes, Ove; Sedrakyan, Art; Prentice, Heather A.; Paxton, Elizabeth W.
Publisher: Journal of Bone and Joint Surgery
Publication year: 2025
Journal:: JB & JS open access
Article number: e25.00061
Volume: 10
Issue: 3
eISSN: 2472-7245
DOI: https://doi.org/10.2106/JBJS.OA.25.00061
Web address : https://doi.org/10.2106/jbjs.oa.25.00061
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/504537010
Background:
The use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is debated. Some argue that ALBC might only be justified in high-risk patients. This study assessed the effectiveness of ALBC vs. plain bone cement (PBC) in reducing risk of revision for periprosthetic joint infection (PJI) in TKA patients considered to have a high risk of infection.
Methods:Cohort study of primary TKAs in 11 national or regional arthroplasty registries from 2010 to 2020. The 1-year risk of revision for PJI in TKAs with ALBC vs. PBC among patients with high American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and/or diabetes was compared. Cumulative percent revision (1 minus Kaplan-Meier) based on 685,818 TKAs and Cox regression analyses (adjusted Hazard Rate Ratios [aHRRs]) were performed for TKAs with ALBC (reference) vs. PBC restricted to the following high-risk subgroups of patients: (1) ASA ≥3 (n = 335,612 vs. 35,997), (2) BMI ≥35 (n = 278,927 vs. 24,737), (3) ASA ≥3 and BMI ≥35 (n = 99,407 vs. 11,407), (4) diabetes (n = 38,341 vs. 21,838), and (5) ASA ≥3, BMI ≥35, and diabetes (n = 3,347 vs. 4,261). Advanced distributed meta-analyses were performed to combine all aggregate data and assess 1-year risk of revision for PJI.
Results:Each registry reported a 1-year cumulative percent revision of ≤1.6% for PJI following TKAs both for ALBC and PBC in all high-risk subgroups. Similar 1-year risks of revision for PJI were found in TKAs with ALBC (reference) and PBC among patients with ASA ≥3 (aHRR: 1.09; 95% CI, 0.90-1.31); BMI ≥35 (1.06; 0.54-2.12); ASA ≥3 and BMI ≥35 (1.12; 0.83-1.50); diabetes (0.95; 0.74-1.20); and ASA ≥3, BMI ≥35, and diabetes (1.40; 0.86-2.29).
Conclusions and Relevance:Similar 1-year revision risk of PJI was found for TKAs with ALBC vs. PBC in high-risk patients. Confirmation of the efficacy of ALBC in high-risk TKA patients needs to be evaluated in clinical trials.
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