Is Dual Antibiotic-Loaded Bone Cement More Effective and Cost-Efficient Than a Single Antibiotic-Loaded Bone Cement to Reduce the Risk of Prosthetic Joint Infection in Aseptic Revision Knee Arthroplasty?

Sanz-Ruíz, Pablo; Matas-Diez, José Antonio; Villanueva‐Martínez, Manuel; Blanco, Alex Dos Santos-Vaquinha; Vaquero, Javier

doi:10.1016/j.arth.2020.06.045

Cited by 27 publications

(26 citation statements)

References 26 publications

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“…Similar to this trend we also observed a statistically significant reduction of PJI cases in aseptic knee revision arthroplasty (risk reduction of 57%), if the high-dose dual cement COPAL G+C was used for the cementation of the revision prosthesis instead of the low-dose cement PALACOS R+G. 51…”

Section: Our Own Experiences With the Dual High-dose Cement Copal G+csupporting

confidence: 83%

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

Sanz-Ruíz

Berberich

2020

ORR

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There is growing body of evidence that important patient-, procedure- and pathogen-related factors are linked to higher risks for prosthetic joint infections (PJI) following arthroplasty surgeries. The prior identification and optimization of such risk factors is considered paramount to minimize the incidence of these infections. Without any doubt, antibiotic prophylaxis remains one of the cornerstones among all preventive measures. However, the ideal antibiotic prophylaxis is still in debate and discussions have emerged, whether certain situations deserve adjustments or variations of the standard protocol taking into account antibiotic resistance surveillance data and patient risk factors for infections. This review aims to provide the reader with an overview of possible antibiotic prophylaxis strategies in response to these risks and discusses the clinical experiences so far obtained. We further present preliminary evidence that the use of a reinforced local antibiotic prophylaxis regimen with high-dose dual antibiotic-loaded bone cement may be an effective and easy-to-apply option in patients at high infection risks.

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Section: Our Own Experiences With the Dual High-dose Cement Copal G+csupporting

confidence: 83%

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

Sanz-Ruíz

Berberich

2020

ORR

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“…While the point-of-care nature of the PEG-PAM/antibiotic coating has several benefits, it does raise the issue of quality control and reproducibility. However, there are several precedents for the optimization of complex intra-operative point-of-care mixtures including antibiotic-loaded bone cement 42 .…”

Section: Discussionmentioning

confidence: 99%

Point-of-care antimicrobial coating protects orthopaedic implants from bacterial challenge

Hegde

Zoller

et al. 2021

Nat Commun

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Implant related infections are the most common cause of joint arthroplasty failure, requiring revision surgeries and a new implant, resulting in a cost of $8.6 billion annually. To address this problem, we created a class of coating technology that is applied in the operating room, in a procedure that takes less than 10 min, and can incorporate any desired antibiotic. Our coating technology uses an in situ coupling reaction of branched poly(ethylene glycol) and poly(allyl mercaptan) (PEG-PAM) polymers to generate an amphiphilic polymeric coating. We show in vivo efficacy in preventing implant infection in both post-arthroplasty infection and post-spinal surgery infection mouse models. Our technology displays efficacy with or without systemic antibiotics, the standard of care. Our coating technology is applied in a clinically relevant time frame, does not require modification of implant manufacturing process, and does not change the implant shelf life.

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“…With an estimated annual cost of US $8659 per patient, diabetes foot care poses an increasing socioeconomic burden for the public health [49]. The cost-effectiveness analyses of ALBC have mostly been done in the knee, hip, and shoulder arthroplasty studies [50][51][52][53][54]. Moreover, in order to achieve the standardization of ALBC use, these studies have investigated factors such as cement/antibiotic mix models [50], quantity of antibiotics loaded [50,51], and nature of bone cement [52][53][54].…”

Section: Discussionmentioning

confidence: 99%

“…The cost-effectiveness analyses of ALBC have mostly been done in the knee, hip, and shoulder arthroplasty studies [50][51][52][53][54]. Moreover, in order to achieve the standardization of ALBC use, these studies have investigated factors such as cement/antibiotic mix models [50], quantity of antibiotics loaded [50,51], and nature of bone cement [52][53][54]. According to the findings, manually mixed models and dual antibiotic-loaded bone cement were more cost-effective than premixed models and single antibiotic-loaded bone cement, respectively [50,51].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in order to achieve the standardization of ALBC use, these studies have investigated factors such as cement/antibiotic mix models [50], quantity of antibiotics loaded [50,51], and nature of bone cement [52][53][54]. According to the findings, manually mixed models and dual antibiotic-loaded bone cement were more cost-effective than premixed models and single antibiotic-loaded bone cement, respectively [50,51]. However, in terms of nature of bone cement, findings showed that ALBC is costlier than plain bone cement (PBC) and brings along some unnecessary financial burden healthcare systems, which might already struggle to maintain high quality of care [52,54].…”

Section: Discussionmentioning

confidence: 99%

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Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial

Ehya

Zhang

et al. 2021

Journal of Diabetes Research

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This study explored the clinical effectiveness of antibiotic-loaded bone cement on primary treatment of diabetic foot infection. This is a randomized controlled study, including thirty-six patients with diabetic foot ulcer complicated by osteomyelitis who had undergone treatment between May 2018 and December 2019. Patients were randomly divided into control group (group A) and study group (group B). Patients in the intervention group received antibiotic-loaded bone cement repair as primary treatment, while patients in the control group received conventional vacuum sealing draining treatment. Clinical endpoints were assessed and compared between the two groups, including wound healing time, wound bacterial conversion, NRS pain score, number of wound dressing changes, and average hospitalization time. All patients were followed up for a period of 12 months after discharge. Results show that compared with the control group, patients in the study group had significant difference in the number of patients for baseline pathogens eradication, short NRS pain score, hospital length of stay and cost, wound surface reduction, healing time, low rate of complications, and infection recurrence. Based on the findings, we conclude that antibiotic-loaded bone cement can be used for treatment of wound in patient with diabetic foot infection. It can help to control wound infections, shorten hospital length of stay, reduce medical cost, and relieve both doctors’ and patients’ burden. The application of antibiotic-loaded bone cement is suitable for diabetic wound with soft tissue infection or osteomyelitis.

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Is Dual Antibiotic-Loaded Bone Cement More Effective and Cost-Efficient Than a Single Antibiotic-Loaded Bone Cement to Reduce the Risk of Prosthetic Joint Infection in Aseptic Revision Knee Arthroplasty?

Cited by 27 publications

References 26 publications

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

<p>Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain</p>

Point-of-care antimicrobial coating protects orthopaedic implants from bacterial challenge

Application and Clinical Effectiveness of Antibiotic-Loaded Bone Cement to Promote Soft Tissue Granulation in the Treatment of Neuropathic Diabetic Foot Ulcers Complicated by Osteomyelitis: A Randomized Controlled Trial

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