Abstract
Background and purpose — To further improve the success of joint replacement surgery, attention needs to be paid to variations associated with improved or worsened outcomes. We investigated the association between the type of bone cement used and the risk of revision surgery after primary total hip replacement.Methods — We conducted a prospective study of data from the National Joint Registry for England and Wales between April 1, 2003 and December 31, 2013. 199,205 primary total hip replacements performed for osteoarthritis where bone cement was used were included. A multilevel over-dispersed piecewise Poisson model was used to estimate differences in the rate of revision by bone cement type adjusted for implant type, head size, age, sex, ASA grade, and surgical approach.Results — The rate of revision was higher in DePuy CMW3 medium viscosity with gentamicin (IRR 2.0, 95% CI 1.5–2.7) and DePuy SmartSet high viscosity plain (IRR 2.7, 95% CI 1.1–5.5), and lower in DePuy CMW1 high viscosity plain (IRR 0.44, 95% CI 0.19–0.89) bone cements compared with Heraeus Palacos high viscosity with gentamicin. Revision rates were similar between plain and antibiotic-loaded bone cement.Interpretation — The majority of bone cements performed similarly well, excluding DePuy SmartSet high viscosity and CMW3 high viscosity with gentamicin, which both had higher revision rates. We found no clear differences by viscosity or antibiotic content.
Highlights
The rate of revision was higher in DePuy CMW3 medium viscosity with gentamicin (IRR 2.0, 95% credible intervals (CI) 1.5–2.7) and DePuy SmartSet high viscosity plain (IRR 2.7, 95% CI 1.1–5.5), and lower in DePuy CMW1 high viscosity plain (IRR 0.44, 95% CI 0.19–0.89) bone cements compared with Heraeus Palacos high viscosity with gentamicin
We investigated the association between the type of bone cements (BC) used and the subsequent risk of revision in individuals undergoing primary total hip replacements (THR), and whether any differences in revision rates could be explained by antibiotic content
This study has demonstrated in 199,205 primary hip replacement procedures that a small number of BCs are associated with an increased risk of revision surgery
Summary
The rate of revision was higher in DePuy CMW3 medium viscosity with gentamicin (IRR 2.0, 95% CI 1.5–2.7) and DePuy SmartSet high viscosity plain (IRR 2.7, 95% CI 1.1–5.5), and lower in DePuy CMW1 high viscosity plain (IRR 0.44, 95% CI 0.19–0.89) bone cements compared with Heraeus Palacos high viscosity with gentamicin. Revision rates were similar between plain and antibiotic-loaded bone cement. There have been a limited number of observational reports describing the efficacy of different bone cements (BC) but it is unclear whether different BCs lead to different revision rates. An observational study using data from the Norwegian Arthroplasty Register showed lower rates of revision for primary THR using ABC with systemic antibiotics in comparison with plain BC with systemic antibiotics (Engesaeter et al 2003). There are only a small number of randomized trials that have investigated the efficacy of ABC in humans (Pfarr and Burri 1979, Wannske and Tscherne 1979, Josefsson et al 1981, McQueen et al 1987, 1990, Chiu et al 2002, Hinarejos et al 2013). We investigated the association between the type of BC used and the subsequent risk of revision in individuals undergoing primary THR, and whether any differences in revision rates could be explained by antibiotic content
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