Abstract
BackgroundAntibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected revision arthroplasty, but its routine use in primary total joint arthroplasty (TJA) remains considerably controversial. With this meta-analysis of published randomized controlled trials, we intended to assess the antimicrobial efficacy and safety of AIBC for its prophylactic use in primary TJA.MethodsA literature search was performed in MEDLINE, Embase, CBMdisc and the Cochrane Library until June, 2013. The studies were divided into two sub-groups according to the type of the control group. Outcomes of interest included postoperative infection rates, radiographic outcomes and clinical joint score. Study quality was evaluated using the Jadad scale (five points).ResultsIn total, eight studies were included, with a sample size of 6,381 arthroplasties. The overall pooled data demonstrated that, compared with the control (plain cement or systemic antibiotic), AIBC did not reveal an advantage in decreasing the rate of superficial infection (relative risk [RR] = 1.47; 95% CI, 1.13–1.91; P=0.004), while there were significant differences in deep infection rate between the AIBC and control group (RR = 0.41; 95% CI, 0.17–0.97; P=0.04). For the analysis of gentamicin and cefuroxime subgroups, the gentamicin was superior to the cefuroxime in reducing deep infection rate (P=0.0005 versus P= 0.10). However, no significant differences were found in their radiographic outcomes and clinical joint score.ConclusionThis meta-analysis had proven that the prophylactic use of AIBC could lower the deep infection rate in primary TJA, while AIBC did not show an improvement in reducing the superficial infection rate compared with the control. More sufficiently powered studies would be required to further evaluate the efficacy and safety of AIBC for primary TJA.
Highlights
The use of prophylactic antibiotics and improvements in the operating room environment have helped to reduce the incidence of infection to less than 1% after primary total hip replacement [1] and to 3% after primary total knee replacement [2]
The remaining 31 studies were retrieved for full papers and 17 articles were excluded because these studies did not involve primary total joint arthroplasty (TJA) or were not randomized controlled trials (RCTs)
6318 arthroplasties were included in our study; 3217 of these arthroplasties received Antibiotic-impregnated bone cement (AIBC) and 3101 arthroplasties served as the control
Summary
The use of prophylactic antibiotics and improvements in the operating room environment have helped to reduce the incidence of infection to less than 1% after primary total hip replacement [1] and to 3% after primary total knee replacement [2]. With the risk of systemic toxicity reduced and sufficient antibiotic concentrations released, local antibiotic delivery is regarded as an effective method to prevent or treat deep infection following TJA, and among current vehicles used for local drug delivery, antibiotic-impregnated bone cement (AIBC) has become the most frequently used standard vehicle [4]. Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected revision arthroplasty, but its routine use in primary total joint arthroplasty (TJA) remains considerably controversial. With this meta-analysis of published randomized controlled trials, we intended to assess the antimicrobial efficacy and safety of AIBC for its prophylactic use in primary TJA.
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