Use Of Antibiotic-loaded Bone Cement Research Articles

Comparable bone penetration between antibiotic-loaded and plain bone cement in total knee arthroplasty.

One of the main concerns around the use of antibiotic-loaded bone cement (ALBC) is the potential reduction in the mechanical properties of the cement when antibiotics are admixed. The purpose of this study was to determine whether there is a difference between plain cement and ALBC in terms of radiological intrusion into the bone in total knee arthroplasties (TKAs). Prospective randomized study of 80 consecutive patients who underwent TKA. Depending on the cement used, patients were divided into two groups by a computer-generated randomization programme: the cement without antibiotic (Group 1) or the ALBC (Group 2). Cement intrusion was measured in postoperative radiographs in eight different regions in the tibial component and six regions in the femoral component. The average cement intrusion was similar in both groups (p = nonsignificance [n.s.]). Group 1 (plain cement) had an average cement intrusion in the femur of 1.4 mm (±0.4) and 2.4 mm (±0.4) in the tibia. In Group 2 (ALBC), the average cement intrusion in the femur came to 1.6 (±0.5) and 2.4 mm (±0.5) in the tibia. In 80% of the patients, the cement intrusion in the tibia averaged a minimum of 2 mm, being similar in both groups (p = n.s.). There are no differences in bone intrusion when comparing plain cement to ALBC. Therefore, the use of ALBC in primary TKA may be indicated, achieving optimal bone penetration. Level I.

Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement

Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient. To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023. Primary TKA with ALBC vs plain bone cement. The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 - Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes. Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement. In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.

A systematic review and meta-analysis of antibiotic-loaded bone cement for prevention of deep surgical site infections following primary total joint replacement

BackgroundThe use of antibiotic-loaded bone cement (ALBC) as a mean for preventing deep surgical site infections (SSI) after total joint replacement is controversial. Therefore, we have conducted a meta-analysis to evaluate the prophylactic effect of ALBC for SSI prevention in patients undergoing arthroplasty. This study was conducted to revise treatment guidelines for MRSA infections in Japan. MethodsPubMed (Medline), Scopus, Embase, Web of Science and Cochrane library were searched for relevant articles comparing preventive effect of ALBC for patients undergoing primary total joint arthroplasty by August 2022. Primary outcome was the incidence of deep SSI. Subgroup analyses by type of surgery (total hip (THA) or knee (TKA) arthroplasty) and by causative pathogen (methicillin-resistant Staphylococcus aureus (MRSA)) were performed. ResultsOf the 3379 studies identified for screening, six studies involving 5745 patients were included. The use of ALBC significantly reduced the incidence of deep SSI in overall patients (risk ratio [RR] 0.60, 95% confidential interval [CI] 0.39–0.92), but the evidence level was very low. There was no significant preventive effect for ALBC compared with non-ALBC in both THA and TKA (THA, RR 0.52, 95% CI 0.23–1.16; TKA, RR 0.64, 95% CI 0.38–1.06), and for preventing MRSA-SSI (RR 0.27, 95% CI 0.03–2.41). ConclusionsAlthough the overall preventive effect of ALBC was significant, the evidence level was very low. Thus, the routine use of ALBC as a mean to prevent SSI in arthroplasty may not be suggested.

Acute postoperative infections after dual head arthroplasty in geriatric patients

Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent amajor challenge with a1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. Atherapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be asingle-stage stem replacement in combination with implantation of acup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16-82%). Surgical treatment should always be followed by antibiotic treatment with atotal duration of 12weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.

Effectiveness of antibiotic-loaded bone cement in total joint arthroplasty at a tertiary medical center: A retrospective cohort study

BackgroundData regarding the effectiveness of antibiotic-loaded bone cement (ALBC) in preventing prosthetic joint infections (PJI) after total joint arthroplasty (TJA) is inconsistent. The objective of this study was to evaluate if the routine use of ALBC influenced the risk of revision surgery due to PJI. MethodsThis is a retrospective cohort study performed between January 2018 and September 2020. Adult patients aged ≥ 18 years who underwent TJA (knee or hip) and received either ALBC or plain cement (PC) were included. The outcome of this study was the rate of revision due to PJI. Multivariate analysis using logistic regression was used to identify factors that may be associated with increased risk of PJI, using STATA 15.1 (StataCorp LP, College Station, Texas, USA). ResultsA total of 844 patients were screened and 319 patients were included. There were 247 patients in ALBC group and 72 patients in the PC group. Only vancomycin powder was used in all ALBC cases, with a 2 g dose in 50% of the cases (dose ranged between 1 g and 8 g). The status of the prosthetic joint was assessed and recorded up to 2 years of the TJA. Overall, the difference in the rates of PJI between the two groups after primary arthroplasty was not statistically significant (5.6% vs 1.4%; p = 0.173; OR, 4.2; 95% CI, 0.5–33). ConclusionALBC was not associated with a reduction in PJI rates after primary TJA. More research is needed to further evaluate the effectiveness of ALBC in preventing PJI.

Does antibiotic bone cement reduce infection rates in primary total knee arthroplasty?

Infection after total knee arthroplasty (TKA) impacts the patient, surgeon, and healthcare system significantly. Surgeons routinely use antibiotic-loaded bone cement (ALBC) in attempts to mitigate infection; however, little evidence supports the efficacy of ALBC in reducing infection rates compared to non-antibiotic-loaded bone cement (non-ALBC) in primary TKA. Our study compares infection rates of patients undergoing TKA with ALBC to those with non-ALBC to assess its efficacy in primary TKA. A retrospective review of all primary, elective, cemented TKA patients over the age of 18 between 2011 and 2020 was conducted at an orthopedic specialty hospital. Patients were stratified into two cohorts based on cement type: ALBC (loaded with gentamicin or tobramycin) or non-ALBC. Baseline characteristics and infection rates determined by MSIS criteria were collected. Multilinear and multivariate logistic regressions were performed to limit significant differences in demographics. Independent samples t test and chi-squared test were used to compare means and proportions, respectively, between the two cohorts. In total, 9366 patients were included in this study, 7980 (85.2%) of whom received non-ALBC and 1386 (14.8%) of whom received ALBC. There were significant differences in five of the six demographic variables analyzed; patients with higher Body Mass Index (33.40 ± 6.27 vs. 32.09 ± 6.21; kg/m2) and Charlson Comorbidity Index values (4.51 ± 2.15 vs. 4.04 ± 1.92) were more likely to receive ALBC. The infection rate in the non-ALBC was 0.8% (63/7,980), while the rate in the ALBC was 0.5% (7/1,386). After adjusting for confounders, the difference in rates was not significant between the two groups (OR [95% CI]: 1.53 [0.69-3.38], p = 0.298). Furthermore, a sub-analysis comparing the infection rates within various demographic categories also showed no significant differences between the two groups. Compared to non-ALBC, the overall infection rate in primary TKA was slightly lower when using ALBC; however, the difference was not statistically significant. When stratifying by comorbidity, use of ALBC still showed no statistical significance in reducing the risk of periprosthetic joint infection. Therefore, the advantage of antibiotics in bone cement to prevent infection in primary TKA is not yet elucidated. Further prospective, multicenter studies regarding the clinical benefits of antibiotic use in bone cement for primary TKA are warranted.

Antibiotic-loaded bone cement vs. plain cement as an infection prophylaxis in primary elective shoulder arthroplasty

HypothesisThe use of antibiotic-loaded bone cement (ABC) in the setting of revision arthroplasty for deep infections is a broadly accepted practice. However, its use in the setting of primary arthroplasty continues to be controversial with few studies assessing the efficacy of ABC for primary total shoulder arthroplasty (TSA). The purpose of this study was to determine whether the use of ABC in primary TSA is associated with a difference in the risk of deep infections. MethodsA retrospective cohort study was conducted using data from a United States integrated health-care system’s shoulder arthroplasty registry. Patients aged ≥18 years who underwent primary elective anatomic TSA for osteoarthritis or reverse TSA (RTSA) for rotator cuff arthropathy with implanted cement information were included in the study (2009-2020). We compared patients that received ABC to those who received plain cement and are at risk of revision due to deep infection within 5 years of follow-up using Cox proportional hazard regression weighted with the inverse propensity score, stratified by procedure type. ResultsThe study sample included 6409 TSAs for osteoarthritis and 779 RTSAs for rotator cuff arthropathy performed by 198 surgeons at 58 hospitals. In the TSA group, 20% received ABC; the cumulative infection probability at 5 years of follow-up was 0.5% and 0.6% for the ABC and plain cement groups, respectively. After covariate adjustment, no significant difference in infection risk was found (hazard ratio = 0.72, 95% confidence interval = 0.43-1.21, P = .216). In the RTSA group, 19% received ABC; the cumulative infection probability at 5 years of follow-up was 2.7% and 0.9% for the ABC and plain cement groups, respectively. After covariate adjustment, no significant difference in infection risk was found between the 2 cement groups (hazard ratio = 1.47, 95% confidence interval = 0.66-3.26, P = .341). ConclusionIn this study of more than 7000 primary elective shoulder arthroplasties performed in patients with a standard risk of infection, antibiotic bone cement did not confer any risk-reduction for periprosthetic infection when compared to plain bone cement. Different at-risk pathogen profiles may develop with prolonged use of antibiotic bone cement.

When and How Should I Use Antibiotic Cement in Primary and Revision Joint Arthroplasty?

Periprosthetic joint infections (PJIs) remain one of the most challenging and devastating complications associated with total joint arthroplasty. Therefore, prevention and the ability to effectively treat PJIs are critical. One such tool for both the prevention and treatment of PJIs is the use of antibiotic-loaded bone cement (ALBC). ALBC provides an effective local delivery method of antibiotics. Low dose (<2 g per 40-g batch) is commonly used for prophylaxis, while high dose (>3.6 g per 40-g batch) is used for the treatment of PJIs. This review focuses on the efficacy, safety, and cost-effectiveness of ALBC for both the prevention as well as the treatment of PJIs.

The use of antibiotic-loaded bone cement does not increase antibiotic resistance after primary total joint arthroplasty

PurposeOne of the preventive strategies for periprosthetic joint infection (PJI) is the use of antibiotic-loaded bone cement (ALBC) in primary total joint arthroplasty (TJA). Even though it is widely used, there are concerns about the development of antibacterial resistance. The aim of the study was to investigate whether using ALBC in primary TJA increases the antibiotic-resistant PJI. The hypothesis was that the regular use of ALBC does not increase the rate of resistant PJI.MethodsPatients with confirmed PJI who had revision surgery from year 2010 to 2019 were included in this international multicenter study. The ALBC group was compared to the non-ALBC TJA group from the same time period. Medical records were used to collect clinical (age, gender, body mass index, comorbidities), TJA-related (type of operation, implant type and survival) and PJI-related (cultured microorganism, antibiogram) data. Resistance to gentamicin, clindamycin and vancomycin were recorded from the antibiograms. Multiple logistic regression model was used to identify risk factors and account for the potential confounders.Results218 patients with PJI were included in the study: 142 with gentamicin-loaded bone cement and 76 in the non-ALBC group. The average age in the ALBC group was 71 ± 10 years and 62 ± 12 years in the comparison group (p < 0.001). Coagulase negative Staphylococci (CONS) were the most common (49%) isolated pathogens. The use of ALBC did not increase the rate of any resistant bacteria significantly (OR = 0.79 (0.42–1.48), p = 0.469). The presence of CONS was associated with higher risk of antibiotic resistance.ConclusionsThe current study demonstrates no increase in antibiotic resistance due to ALBC after primary TJA. Thus, the use of ALBC during primary TJA should not be feared in the context of antimicrobial resistance.Level of evidenceIII.

A randomized clinical trial of low dose single antibiotic-loaded cement versus high dose dual antibiotic-loaded cement in patients receiving a hip hemiarthroplasty after fracture: A protocol for the WHiTE 8 COPAL study.

AimsPatients receiving cemented hemiarthroplasties after hip fracture have a significant risk of deep surgical site infection (SSI). Standard UK practice to minimize the risk of SSI includes the use of antibiotic-loaded bone cement with no consensus regarding type, dose, or antibiotic content of the cement. This is the protocol for a randomized clinical trial to investigate the clinical and cost-effectiveness of high dose dual antibiotic-loaded cement in comparison to low dose single antibiotic-loaded cement in patients 60 years and over receiving a cemented hemiarthroplasty for an intracapsular hip fracture.MethodsThe WHiTE 8 Copal Or Palacos Antibiotic Loaded bone cement trial (WHiTE 8 COPAL) is a multicentre, multi-surgeon, parallel, two-arm, randomized clinical trial. The pragmatic study will be embedded in the World Hip Trauma Evaluation (WHiTE) (ISRCTN 63982700). Participants, including those that lack capacity, will be allocated on a 1:1 basis stratified by recruitment centre to either a low dose single antibiotic-loaded bone cement or a high dose dual antibiotic-loaded bone cement. The primary analysis will compare the differences in deep SSI rate as defined by the Centers for Disease Control and Prevention within 90 days of surgery via medical record review and patient self-reported questionnaires. Secondary outcomes include UK Core Outcome Set for hip fractures, complications, rate of antibiotic prescription, resistance patterns of deep SSI, and resource use (more specifically, cost-effectiveness) up to four months post-randomization. A minimum of 4,920 patients will be recruited to obtain 90% power to detect an absolute difference of 1.5% in the rate of deep SSI at 90 days for the expected 3% deep SSI rate in the control group.ConclusionThe results of this trial will provide evidence regarding clinical and cost-effectiveness between low dose single and high dose dual antibiotic-loaded bone cement, which will inform policy and practice guidelines such as the National Institute for Health and Care Excellence guidance on management of hip fractures.Cite this article: Bone Jt Open 2021;2(2):72–78.

330. Risk Factors for Acute Kidney Injury after the Use of Antibiotic Loaded Bone Cement in Orthopedic Surgery – a Retrospective Case-control Study

BackgroundAs the number of joint replacement surgeries continues to rise, so does the number of joint infections. Many patients end up needing the implantation of antibiotic loaded bone cement (ALBC) to treat their infection. The use of localized high dose vancomycin, tobramycin, and gentamicin may be linked to acute kidney injury (AKI) in certain patients. Our hypothesis is that patients who developed AKI after receiving a joint spacer had a predisposition to AKI due to other comorbidities, high antibiotic doses in ALBC, immunosuppression, or the use of other nephrotoxic drugs pre-op. These patients may need close monitoring of their renal function and serum antibiotic levels after surgery.MethodsWe performed a chart review of 428 patients who underwent an orthopedic surgery that involved insertion of ALBC at our institution between 2015 and 2018. We excluded patients under age 18, those who had antibiotic irrigation only, trauma patients, non-arthroplasty surgeries (such as fractures and debridement of deep wounds), and patients with missing data for 30 days after the surgery. We identified 57 patients who fit our inclusion criteria and received a bone cement spacer or beads to treat an infection of the hip, knee, shoulder, or ankle. We matched patients who had AKI to 2 patients who did not have AKI. Matching was based on age (± 5 years), joint operated on, and antibiotics used.Results15 patients showed an elevated serum creatinine level of over 1.2 within 30 days of surgery. 86.7% of these patients were male, their average age was 64.1 ± 6.2 years old, 40% had hip surgery, 46.7% knee surgery, 6.7% ankle, and 6.7% shoulder. All received vancomycin and tobramycin in Palacos bone cement. Compared to their case-control matches, these patients had more frequent use of immunosuppressive medication, a history of malignancy, a history of previous kidney disease, and obesity. The use of combined intravenous vancomycin and piperacillin-tazobactam post-operatively may also be linked to higher rates of AKI.ConclusionImmunosuppression, obesity, male gender, and history of kidney injury and cancer are factors associated with AKI after ALBC spacer implantation. Further analysis and study are needed to identify potential causation between ALBC use and AKI.Disclosures All Authors: No reported disclosures

Is the use of antibiotic-loaded bone cement associated with a lower risk of revision after primary total hip arthroplasty?

The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis. The cohort included 418,857 THAs of whom 397,896 had received antibiotic-loaded bone cement and 20,961 plain cement. After adjusting for putative confounding factors, the risk of revision for PJI was lower in those in whom antibiotic-loaded bone cement was used (hazard ration (HR) 0.79; 95% confidence interval (CI) 0.64 to 0.98). There was also a protective effect on the risk of revision due to aseptic loosening or osteolysis, in the period of > 4.1 years after primary THA, HR 0.57, 95% CI 0.45, 0.72. Within the limits of registry analysis, this study showed an association between the use of antibiotic-loaded bone cement and lower rates of revision due to PJI. The findings support the continued use of antibiotic-loaded bone cement in cemented THA. Cite this article: Bone Joint J 2020;102-B(8):997-1002.

Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should be use antibiotic-loaded bone cement?

IntroductionProsthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MaterialA retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. ResultsIn the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2–78.7 %) (P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. ConclusionsThe use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.

Infección periprótesica en pacientes ancianos tratados mediante hemiartroplastia de cadera tras fractura intracapsular. ¿Debemos usar cementación con antibiótico?

IntroductionProsthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MaterialA retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. ResultsIn the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2-78.7%, P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. ConclusionsThe use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.

The Economics of Antibiotic Cement in Total Knee Arthroplasty: Added Cost with No Reduction in Infection Rates

BackgroundTo reduce the substantial clinical and financial burden of periprosthetic joint infection (PJI), some surgeons advocate for the use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA), although its effectiveness continues to be debated in the literature. The purpose of this study was to determine whether the routine use of ALBC is cost-effective in reducing PJI after primary TKA. MethodsWe retrospectively reviewed a consecutive series of patients undergoing cemented primary TKA at two hospitals within our institution from 2015 to 2017. We compared demographics, comorbidities, costs, and PJI rates between patients receiving ALBC and plain cement. We performed a multivariate regression analysis to determine the independent effect of ALBC on PJI rate. We calculated readmission costs for PJI and reduction in PJI needed to justify the added cost of ALBC. ResultsOf 2511 patients, 1077 underwent TKA with ALBC (43%), with no difference in PJI rates (0.56% vs 0.14%, P = .0662) or complications (1.2% vs 1.6%, P = .3968) but higher cement costs ($416 vs $117, P < .0001) and overall procedure costs ($6445 vs $5.968, P < .0001). ALBC had no effect on infection rate (P = .0894). Patients readmitted with PJI had higher overall 90-day episode-of-care claims costs ($49,341 vs $19,032, P < .001). To justify additional costs, ALBC would need to prevent infection in one of every 101 patients. ConclusionRoutine use of ALBC in primary TKA is not cost-effective, adding $299 to the cost of episode of care without a reduction in PJI rate. Further study is needed to determine whether select use of ALBC would be justified in high-risk patients.

Antibiotic-Loaded Bone Cement in Primary Total Knee Arthroplasty: Utilization Patterns and Impact on Complications Using a National Database

BackgroundThe routine usage of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is controversial. Its effectiveness in reducing infection risk remains unclear while high-dose antibiotics can lead to multiple adverse effects. The purpose of this population-based study is to evaluate utilization patterns of ALBC in primary TKA and its impact on clinical outcomes. MethodsThis retrospective cohort study used data from the nationwide Premier Healthcare claims database (2006-2016). Multivariable models estimated associations between ALBC use and early postoperative infection, kidney injury, allergic reaction, hospital readmission, cost, and length of stay. ResultsALBC was used in 27.2% of all primary TKAs (N = 1,184,270). Usage increased from 17.3% to 30.2% in 2006-2010, then plateaued. Study covariates differed minimally between groups, suggesting nonselective ALBC use. Utilization was lower in rural (21.4%) and higher in large (>500 beds; 29.4%) hospitals. After adjusting for relevant covariates, ALBC use was associated with significantly decreased odds for early postoperative infection (odds ratio, 0.89; confidence interval, 0.83-0.96) and increased odds for acute kidney injury (odds ratio, 1.06; confidence interval, 1.02-1.11). ConclusionWith utilization rates of around 30%, we found that ALBC reduced odds for early postoperative infection and increased odds for kidney injury. Strong consideration should be given for selective use of ALBC in primary TKA.

Does the Use of Antibiotic-Loaded Bone Cement Have an Effect on Deep Infection in Primary Total Knee Arthroplasty Practice?

Total knee arthroplasty (TKA) is performed to improve the quality of life by reducing knee arthralgia. One of the most destructive and expensive complications of TKA is deep infection. The primary purpose of this study was to evaluate the effect of using antibiotic-loaded bone cement (ALBC) on the incidence of deep infection after primary TKA. A total of 506 patients who underwent primary knee arthroplasty at the Antalya Training and Research Hospital between February 2009 and January 2016 were investigated retrospectively. The ALBC was used for 85 patients (16.7%), who constituted group 1. Plain bone cement was used for 421 patients (83.2%), who constituted group 2. Deep infection was observed in one patient (1.1%) in group 1 and in six patients (1.4%) in group 2, a difference that is not statistically significant. On average, the deep infection occurred six months after the surgery at the earliest and 19 months at the latest. Use of ALBC did not decrease the incidence of deep infection in TKA. Therefore, we prefer bone cement without any antibiotic.

The effectiveness of antibiotic-loaded bone cement for preventing postoperative infection in patients undergoing total knee arthroplasty

The study question focuses on the effectiveness of antibiotic-loaded bone cement (ALBC) for preventing postoperative infection in patients undergoing total knee arthroplasty (TKA). Infection has remained being a rare but serious complication after TKA. However, the utilization of ALBC for reducing the occurrence of infection is debated. We used the National Inpatient Database, which was provided by National Health Research Institutes. We included 16,108 TKA adult patients between January and November, 2012. There were 5,605 patients (34.8%) using ALBC. The postoperative 30-day infection and acute kidney failure were compared. We adopted multi-level logistic regression models to regulate for potential confounding factors considerately of hospital levels (including medical centers, metropolitam hospitals, and native communitiy hospitals). The odds ratio (OR) of the infection in ALBC use group and 95% confidence interval (CI) were estimated. The main compositions of ALBC are vancomycin (71.7%), followed by gentamicin (30.7%), and cefuroxime (12.4%). Among patients with ALBC use, 83.8% patient had one sort of antibiotics, nevertheless 16.0% patients had two combided antibiotics. We found that the utilization of ALBC couldn't reduce the postoperative 30-day infection. When conducting multilevel logistic regression model, there remained no favorable effect of ALBC in reducing postopeartive infection (OR= 0.80, 95% CI: 0.50-1.26, p= 0.329). For risk of acute kidney failure for ALBC users, the sample size (n=7) is just too small to evaluate. In conclusion, there was no significant advantage of ALBC in reducing postoperative 30-day infection in patients undergoing TKA. During the past 20 years, antibiotic-loaded hip and knee spacers became a well-liked method of managing such infections with reported success rates of > 90% 2- 3. Complications are rather infrequent and consist mostly of mechanical (spacer fracture, dislocation, bone fracture) and people associated with the antibiotic impregnation of bone cement (reinfection/infection persistence, systemic side effects such as renal or hepatic failure, allergic reactions). The release of the antibiotic from the cement is influenced by the type (viscosity) of the cement, by the surface of contact/exchange, by the conditions of the compound, and the type and amount of antibiotic. The antibiotic is released from the surface of the cement and from cracks and voids in the cement itself. The nature of the polymer allows the passage of fluids, allowing the discharge of the incorporated antibiotic. Nevertheless, while the hydrophobicity of the cement limits this release at less than the 10%, most of the antibiotic is released within the first hours and days after surgery. In addition, a significant amount should be trapped in cement for a while. At the time of the preparation, when mixed, it becomes a viscous material paste, which solidifies very quickly by an exothermic reaction. It acts as a fixation between the prosthetic components and the cancellous bone. During the mixing, pores of various sizes are produced as consequence of the reaction and volume variations. These microholes may represent the beginning point of cracks and thus are often responsible of the premature failure of the cement. To avoid the formation of those pores, it's possible to organize the cement under vacuum conditions.

Therapeutic Use of Antibiotic-loaded Bone Cement in the Treatment of Hip and Knee Joint Infections.

The use of antibiotic-loaded cement spacers is an established method in the management of periprosthetic hip and knee joint infections. Despite inconsistencies among published studies, data shows that infection control rates exceed 90% with two-stage exchange arthroplasty. The present work reviews the current literature about antibiotic-loaded cement spacers and concentrates on the indications for spacer implantation, spacer production details, antibiotic impregnation, pharmacokinetic properties, clinical success, mechanical complications, and systemic safety.

Is the Commercial Antibiotic-Loaded Bone Cement Useful in Prophylaxis and Cost Saving After Knee and Hip Joint Arthroplasty? The Transatlantic Paradox

BackgroundThe use of antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic infection (PPI) after total hip (THA) and knee arthroplasty (TKA). However, the economic benefit of using ALBC routinely remains controversial. MethodsA total of 2518 patients subjected to THA, partial hip arthroplasty, and TKA between 2009 and 2012 were identified in our prospectively collected registry. Two groups were defined: before (2009-2010) and after the introduction of ALBC (2011-2012). The risks of PPI associated with each type of surgery in each group were determined and compared. Patients subjected to THA without cemented implants were used as controls, and possible bias associated with changes in infection rate during the study period and other variables were controlled. The costs of the use of ALBC were calculated, along with the savings per case of PPI avoided. The minimum follow-up for discarding PPI was 2 years. ResultsFollowing the introduction of ALBC, a global decrease of 57% was observed in the risk of PPI (P = .001). By type of surgery, the decrease was 60.6% in the case of TKA (P = .019) and 72.6% in the case of cemented hip arthroplasty (partial and total; P = .009). No decrease in infection rate was noted in uncemented hip arthroplasty (P = .42). The total saving associated with the use of ALBC was €1,123,846 (€992 per patient): €440,412 after TKA (€801 per patient) and €686,644 after cemented hip arthroplasty (€2672 per patient). ConclusionThe use of ALBC has been found to be effective in preventing PPI after TKA and hip arthroplasty, with a favorable cost-efficiency profile using standardized cost and infection rates in our setting.