Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients

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.
Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients

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.
Katso/Avaa
Lataukset: 

Journal of Bone and Joint Surgery
doi:10.2106/JBJS.OA.25.00061
URI
https://doi.org/10.2106/jbjs.oa.25.00061
Näytä kaikki kuvailutiedot
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe202601216021
Tiivistelmä

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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