Abstract
BackgroundAntibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement.MethodsFifteen of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision.ResultsMean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e., switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement (p = 0.031): the nine revised patients reported a significant symptom relief (p = 0.028), contrary to the six unrevised patients (p = 0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity (p = 0.05).ConclusionIn symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.
Highlights
Antibiotic-loaded bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure
With an ever-aging population, the demand of Total joint replacement (TJR) is on the rise
When symptoms persist despite an inconclusive work-up, rare conditions like implant allergy or adverse reactions should be considered as diagnoses of exclusion
Summary
Antibiotic-loaded ( gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. There is a serious, yet frequent drawback to this success story: 9% of all TJR surgeries are complication-related revisions [3]. With an annual incidence of 1 to 3%, periprosthetic infection (PPI) brings about poor clinical outcomes and technically difficult revision surgery [4, 5]. The annual economic burden of infectious joint revisions is projected to exceed $1.5 billion by the end of 2019 [7]. Many attempts have been undertaken to reduce the incidence of PPIs, such as administering systemic antibiotics, or the use of antibiotic-loaded bone cement (ALBC)
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