The cost-effectiveness of antibiotic-loaded bone cement versus plain bone cement following total and partial knee and hip arthroplasty

Hoskins, Tyler; Shah, Jash; Patel, Jay; Mazzei, Chris; Goyette, David; Poletick, Eileen; Colella, Thomas; Wittig, James C.

doi:10.1016/j.jor.2020.01.029

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…We believe the fundamental principles and biological advantages of TBB found in the present study can be applied to various PMMA-based materials loaded with other ingredients. Specifically, the effect of the use of TBB on antibiotic-impregnated bone cements [1,[65][66][67] and calcium phosphate/hydroxyapatite and PMMA composites [68][69][70][71] should be examined. Further, comparisons between PMMA-TBB materials and currently used calcium phosphate bone cements and ceramic-based materials will be of great interest.…”

Section: Discussionmentioning

confidence: 99%

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

Hamajima

Ozawa

Saruta

et al. 2020

IJMS

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Acrylic bone cement is widely used in orthopedic surgery for treating various conditions of the bone and joints. Bone cement consists of methyl methacrylate (MMA), polymethyl methacrylate (PMMA), and benzoyl peroxide (BPO), functioning as a liquid monomer, solid phase, and polymerization initiator, respectively. However, cell and tissue toxicity caused by bone cement has been a concern. This study aimed to determine the effect of tri-n-butyl borane (TBB) as an initiator on the biocompatibility of bone cement. Rat spine bone marrow-derived osteoblasts were cultured on two commercially available PMMA-BPO bone cements and a PMMA-TBB experimental material. After a 24-h incubation, more cells survived on PMMA-TBB than on PMMA-BPO. Cytomorphometry showed that the area of cell spread was greater on PMMA-TBB than on PMMA-BPO. Analysis of alkaline phosphatase activity, gene expression, and matrix mineralization showed that the osteoblastic differentiation was substantially advanced on the PMMA-TBB. Electron spin resonance (ESR) spectroscopy revealed that polymerization radical production within the PMMA-TBB was 1/15–1/20 of that within the PMMA-BPO. Thus, the use of TBB as an initiator, improved the biocompatibility and physicochemical properties of the PMMA-based material.

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Section: Discussionmentioning

confidence: 99%

“…The prevalence of skeletal diseases and disorders is on a sharp increase, due to the ageing population. Polymethyl methacrylate (PMMA)-based bone cements are widely used for treating these conditions [1][2][3][4][5]. Specifically, they are used to fix metallic implants and restore fractured or diseased spines, bones, and joints.…”

Section: Introductionmentioning

confidence: 99%

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

Hamajima

Ozawa

Saruta

et al. 2020

IJMS

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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%

“…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]. In this current study, data analyses showed that the ALBC attributed to study group patients was significantly more cost-effective than the VSD allocated to control group patients.…”

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

Leta,

Lie,

Fenstad

et al. 2024

JAMA Netw Open

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ImportanceDespite 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.ObjectiveTo compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement.Design, Setting, and ParticipantsThis 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.ExposurePrimary TKA with ALBC vs plain bone cement.Main Outcomes and MeasuresThe 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.ResultsAmong 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.Conclusions and RelevanceIn 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.

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The cost-effectiveness of antibiotic-loaded bone cement versus plain bone cement following total and partial knee and hip arthroplasty

Cited by 19 publications

References 25 publications

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

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

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

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

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