Influence of Fixation Methods on Prosthetic Joint Infection Following Primary Total Knee Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies

Abstract

The type of fixation used in primary total knee replacement (TKR) may influence the risk of prosthetic joint infection (PJI). We conducted a systematic review and meta-analysis to assess published evidence linking type of fixation (cemented, uncemented, or hybrid) with the risk of PJI following primary TKR. Randomised controlled trials (RCTs) and observational cohort studies comparing fixation methods and reporting PJI incidence following primary TKR were identified in MEDLINE, Embase, Web of Science, and Cochrane Library up until November 2018. Summary measures were relative risks (RR) with 95% confidence intervals (CIs). We identified 32 eligible articles (24 observational studies and 8 RCTs) involving 1,161,292 TKRs. In pooled analysis of observational studies, uncemented fixation was associated with a decreased overall PJI risk when compared with cemented fixation at 0.76 (0.64–0.89). Comparing antibiotic-loaded cemented fixation with plain cement, there was no significant difference in overall PJI risk at 0.95 (0.69–1.31), but PJI risk was increased in the first 6-month postoperative period to 1.65 (1.12–2.43). Limited data from RCTs showed no differences in PJI risk among the fixation types. Observational evidence suggests uncemented fixation may be associated with lower PJI risk in primary TKR when compared with cemented fixation. In the early postoperative period, antibiotic-loaded cemented fixation may be associated with increased PJI risk when compared with plain cement. This may either reflect appropriate selection of higher risk patients for the development of PJI to cemented and antibiotic-loaded cement or may reflect a lower PJI risk in uncemented TKR due to factors such as shorter operative time.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…Still, it is possible to identify the fault in advance when processing sufficiently large samples of patients. If joint replacement registries uncover a higher Several researchers have sought to summarize the evidence from studies with large heterogeneity in terms of patients, methodology, confounding factors, or outcomes [209][210][211]. Adding a new intervention to the relatively robust multi-component and multi-level preventative system gives information only on the performance of the whole system after adding a new intervention, not on the pure performance of an individual measurement.…”

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…The top three comparison studies focused on cemented vs. cementless total joint arthroplasty, the outcome of using different types of spacers, and the outcome of one-stage vs. two-stage exchange. Cemented fixations were revealed to increase the overall PJI risk in comparison to uncemented fixations [66][67][68]. Interestingly, there was no significant difference in the eradication rate between articulating and static spacers in the infected knee replacement [69,70].…”

Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

“…The top three comparison studies focused on cemented vs. cementless total joint arthroplasty, the outcome of using different types of spacers, and the outcome of one-stage vs. two-stage exchange. Cemented fixations were revealed to increase the overall PJI risk in comparison to uncemented fixations [34][35][36]. Interestingly, there was no significant difference in the eradication rate between articulating and static spacers in the infected knee replacement [37,38].…”