Audiometric threshold shifts after total knee arthroplasty by using gentamicin-loaded bone cement

Adem Çöbden

doi:10.3906/sag-1710-135

Abstract

Background/aim The aim of this study was to investigate postoperative audiometric threshold shifts in patients who underwent primary total knee arthroplasty (TKA) using gentamicin-loaded bone cement (GLBC) in comparison with the ones who underwent TKA without GLBC.Materials and methods Forty patients (gentamicin group) who underwent primary TKA using GLBC and 29 patients (control group) who underwent primary TKA using standard bone cement were included in this prospective case-control study. Baseline pure-tone audiometric evaluation was performed preoperatively and repeated at the postoperative third day for all patients. Control audiometric evaluation was performed weekly for patients who were diagnosed with ototoxicity according to audiometric threshold shifts. Results Ototoxicity was diagnosed in 8 of 40 patients (20%) in the gentamicin group according to postoperative audiometric threshold shifts, whereas no ototoxicity was observed in the control group. Patients who were diagnosed with ototoxicity had no permanent audiometric threshold shifts in follow-up audiometric evaluation and these patients had no clinical complaints of difference in hearing. Conclusion According to our results, audiometric threshold shifts can be detected in patients who undergo primary TKA using gentamicin loaded bone cement. However, no permanent shifts were observed during close follow-up.

Highlights

Cemented fixation is the most preferred method for total knee arthroplasty (TKA) among orthopedic surgeons, accepted as the gold standard according to our current knowledge [1,2]
Ototoxicity was diagnosed in 8 of 40 patients (20%) in the gentamicin group according to postoperative audiometric threshold shifts, whereas no ototoxicity was observed in the control group
Patients who were diagnosed with ototoxicity had no permanent audiometric threshold shifts in follow-up audiometric evaluation and these patients had no clinical complaints of difference in hearing

Summary

Introduction

Cemented fixation is the most preferred method for total knee arthroplasty (TKA) among orthopedic surgeons, accepted as the gold standard according to our current knowledge [1,2]. Use of antibiotic-loaded bone cement (ALBC) in the primary TKA procedure has become a favorable option to prevent deep wound infection, which is a devastating complication after total joint arthroplasty [3]. Prophylactic systemic antibiotic administration may not be effective enough to prevent deep wound infection when used on its own. ALBCs are used to achieve a local antimicrobial effect and their prophylactic use has been shown to be associated with lower risk of infection-based revision [4]. Some concerns exist about routine use of ALBCs in TKA; these are the possibility of antibiotic resistance, allergic reaction, Gentamicin is an aminoglycoside antibiotic, which provides local administration in the treatment of infection and has the advantages of high local concentrations, prolonged release, and low serum concentrations with its pharmacodynamic and pharmacokinetic properties [7,8].

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