Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review

Panni, Alfredo Schiavone; Corona, Katia; Giulianelli, M.; Mazzitelli, Giuseppe; Regno, Chiara Del; Vasso, Michele

doi:10.1007/s00167-016-4301-0

Cited by 42 publications

(22 citation statements)

References 26 publications

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“…In a more detailed look at these studies, there was one systematic review that analyzed over 6300 primary TKAs and THAs that showed no statistically significant differences in the rates of deep infection or superficial infection between the group that used AIBC and the group that used PBC[ 7 ]. Similar results were found in two other systematic reviews published in 2015 and 2016 as well[ 14 , 15 ]. However, these studies did not include the most up-to-date articles on primary and revision TKA procedures.…”

Section: Introductionsupporting

confidence: 91%

“…Josefsson et al[ 28 ] proposed that the antibiotics from loaded cement do not reach the superficial parts of the wound in a sufficient concentration to prevent infection. This gave one explanation for the lack of statistical significance in superficial infection rates found throughout literature reviews as well[ 7 , 13 - 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, the use of prophylactic antibiotics and antiseptics in both primary and revision TJA have been explored through systematic reviews found on PubMed[ 7 , 13 - 15 ]. Although interest in the area of antibiotics and antiseptics on infection rates in both primary and revision TKA and THA procedures has increased, there has been a lack of high quality information published in systematic reviews to draw relevant conclusions from[ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

Kleppel¹,

Stirton²,

Liu³

et al. 2017

WJO

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AIMTo compare infection rates in primary and revision total knee arthroplasty (TKA) procedures using antibiotic impregnated bone cement (AIBC) to those rates in procedures not using AIBC.METHODSA systematic review and meta-analysis was conducted in search for randomized controlled trials/studies (RCTs) pertaining to the field of antibiotic AIBC vs non-AIBC groups in both primary and revision TKA procedures. The primary literature search performed was to identify all RCTs that assessed AIBC in primary and revision TKA procedures. This search was done strictly through the PubMed database using the article “filters” setting that identified and separated all RCTs from the overall search. The original search was “Primary/revision total knee arthroplasty using AIBC”. Other key terms and phrases were included in the search as well. Eligible articles that were used in the “results” of this review met the following criteria: (1) Involved primary or revision TKA procedures (for any reason); (2) included TKA outcome infection rate information; (3) analyzed an AIBC group vs a non-AIBC control group; (4) were found through the RCT filter or hand search in PubMed; and (5) published 1985-2017. Exclusion criteria was as follows: (1) Patients that were not undergoing primary or revision TKA procedures; (2) articles that did not separate total hip arthroplasity (THA) vs TKA results if both hip and knee revisions were evaluated; (3) papers that did not follow up on clinical outcomes of the procedure; (4) extrapolation of data was not possible given published results; (5) knee revisions not done on human patients; (6) studies that were strictly done on THAs; (7) articles that were not found through the RCT filter or through hand search in PubMed; (8) articles that did not evaluate AIBC used in a prosthesis or a spacer during revision; (9) articles that did not compare an AIBC group vs a non-AIBC control group; and (10) articles that were published before 1985.RESULTSIn total, 11 articles were deemed eligible for this analysis. Nine of the 11 studies dealt with primary TKA procedures comparing AIBC to non-AIBC treatment. The other two studies dealt with revision TKA procedures that compared such groups. From these papers, 4092 TKA procedures were found. 3903 of these were primary TKAs, while 189 were revision TKAs. Of the 3903 primary TKAs, 1979 of these used some form of AIBC while 1924 were part of a non-AIBC control group. Of the 189 revision TKAs, 96 of these used some form of AIBC while 93 were part of a non-AIBC control group. Average follow-up times of 47.2 mo and 62.5 mo were found in primary and revision groups respectively. A two-tailed Fisher’s exact test was done to check if infection rates differed significantly between the groups. In the primary TKA group, a statistically significant difference between AIBC and non-AIBC groups was not found (AIBC infection rate = 23/1979, non-AIBC infection rate = 35/1924, P = 0.1132). In the revision TKA group, a statistically significant difference between the groups was found (AIBC i...

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Section: Introductionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

Kleppel¹,

Stirton²,

Liu³

et al. 2017

WJO

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show abstract

“…Despite strong evidence of high local antibiotic concentrations, both immediately after implantation and sustainably over several months, [17][18][19] its clinical bene t remains controversial: while some meta-analyses report a signi cantly reduced PPI rate in primary and revision arthroplasty, [20,21] others found no effect. [22,23] This discrepancy is further aggravated by several key disadvantages, such as the development of antibiotic resistant bacterial strains, [24,25] thermal injury to surrounding tissues, [26,27] economical expenses for hospitals and tax payers, [28] and the risk of allergenic potential to surgeons and patients. [29][30][31] We recently reported on 250 patients who had been referred to our outpatient allergy clinic with a history of complicated cemented arthroplasty and suspected implant allergy.…”

Section: Introductionmentioning

confidence: 99%

The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery, a case control follow-up study and algorithmic approach

Thomas

Benedikt

Alamri

et al. 2020

Preprint

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Background Antibiotic-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. Methods 15 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. Results Mean 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). Conclusion In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.

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“…Despite strong evidence of high local antibiotic concentrations, both immediately after implantation and sustainably over several months, [17][18][19] its clinical benefit remains controversial: while some meta-analyses report a significantly reduced PPI rate in primary and revision arthroplasty, [20,21] others found no effect. [22,23] This discrepancy is further aggravated by several key disadvantages, such as the development of antibiotic resistant bacterial strains, [24,25] thermal injury to surrounding tissues, [26,27] economical expenses for hospitals and tax payers, [28] and the risk of allergenic potential to surgeons and patients. [29][30][31] We recently reported on 250 patients who had been referred to our outpatient allergy clinic with a history of complicated cemented arthroplasty and suspected implant allergy.…”

mentioning

confidence: 99%

The role of antibiotic-loaded bone cement in complicated knee arthroplasty relevance of gentamicin allergy and benefit from revision surgery,  a case control follow-up study

Thomas¹,

Benedikt²,

Alamri³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Antibiotic-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. Methods: 15 of these 25 patients and their treating orthopaedic surgeons agreed to a reassessment. They were surveyed regarding interim course of therapy and symptoms, including reassessment 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.Results: Mean 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). Conclusion:In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.

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Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review

Abstract: III.

Cited by 42 publications

References 26 publications

Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery, a case control follow-up study and algorithmic approach

The role of antibiotic-loaded bone cement in complicated knee arthroplasty relevance of gentamicin allergy and benefit from revision surgery,  a case control follow-up study

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Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review

Abstract: III.

Cited by 42 publications

References 26 publications

Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

Antibiotic bone cement’s effect on infection rates in primary and revision total knee arthroplasties

The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery, a case control follow-up study and algorithmic approach

The role of antibiotic-loaded bone cement in complicated knee arthroplasty relevance of gentamicin allergy and benefit from revision surgery, a case control follow-up study

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The role of antibiotic-loaded bone cement in complicated knee arthroplasty relevance of gentamicin allergy and benefit from revision surgery,  a case control follow-up study