Bone cement product and failure in total knee arthroplasty

Abstract

Background and purpose — The bone cement market for total knee arthroplasty (TKA) in Norway has been dominated by a few products and distributors. Palacos with gentamicin had a market share exceeding 90% before 2005, but it was then withdrawn from the market and replaced by new slightly altered products. We have compared the survival of TKAs fixated with Palacos with gentamicin with the survival of TKAs fixated with the bone cements that took over the market.Patients and methods — Using data from the Norwegian Arthroplasty Register for the period 1997–2013, we included 26,147 primary TKAs in the study. The inclusion criteria were TKAs fixated with the 5 most used bone cements and the 5 most common total knee prostheses for that time period. 6-year Kaplan-Meier survival probabilities were established for each cement product. The Cox proportional hazards regression model was used to assess the association between bone cement product and revision risk. Separate analyses were performed with revision for any reason and revision due to deep infection within 1 year postoperatively as endpoints. Adjustments were made for age, sex, diagnosis, and prosthesis brand.Results — Survival was similar for the prostheses in the follow-up period, between the 5 bone cements included: Palacos with gentamicin, Refobacin Palacos R, Refobacin Bone Cement R (Refobacin BCR), Optipac Refobacin Bone Cement R (Optipac Refobacin BCR), and Palacos R + G.Interpretation — According to our findings, the use of the new bone cements led to a survival rate that was as good as with the old bone cement (Palacos with gentamicin).

The Effect of TBB, as an Initiator, on the Biological Compatibility of PMMA/MMA Bone Cement

“…It will be of great importance to determine whether the PMMA-TBB material can avoid in vivo pathologic changes by its polymerization temperature in a future study. In particular, antibiotics containing bone cements have become common recently, and their effectiveness is known to be susceptible to the temperature of the bone cement [2,59].…”

Early migration of a medially stabilized total knee arthroplasty

“…Refobacin Bone Cement R has been used for several years at our hospital, and several studies including registry and RSA studies suggest that this cement gives good fixation and long-term survivorship. 36 - 38 The GMK Sphere has a shorter but wider wing of the keel than for instance the NexGen CR (Zimmer Biomet) and the Triathlon CR (Stryker, USA), both known for their excellent survivorship. 39 In theory, this could increase the rotation of the implant.…”

Studying Biofilm and Clinical Issues in Orthopedics

“…The meta-analysis performed by the CDC guidelines group, concluded that there were “ uncertain trade-offs between the benefits and harms ” and no recommendation was provided (Berrios-Torres et al, 2017). Importantly, the most common antibiotics incorporated into cement are aminoglycoside antibiotics, whereas only one trial has examined gentamicin (Josefsson and Kolmert, 1993), all other randomized controlled trials examined the incorporation of cefuroxime into cement (Birkeland et al, 2017). Despite this, the use of antibiotic-loaded cement is routinely performed in many centers (International Consensus Meeting on Periprosthetic Joint Infection, 2013).…”