The effect of antibiotic-loaded bone cement on risk of revision following hip and knee arthroplasty

Farhan-Alanie, Muhamed M; Burnand, Henry; Whitehouse, Michael R

doi:10.1302/0301-620x.103b1.bjj-2020-0391.r1

Cited by 24 publications

(17 citation statements)

References 39 publications

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“…In a recent meta-analysis, Sebastian et al reported that antibiotic-loaded bone cements (ALBCs) are effective in reducing PJI following primary total joint arthroplasty, with a reduction in risk of between 20 and 84% [ 14 ]. Similar results were reported in total hip arthroplasty [ 15 ]. S. aureus and coagulase-negative staphylococci (CoNS) are used as model microorganisms in in vitro studies exploring the potential of ALBCs for the prevention of PJIs [ 18 , 19 , 20 ].…”

Section: Introductionsupporting

confidence: 90%

“…The interest in using ALBCs for prosthesis fixation during revision arthroplasties has been highlighted in several studies, even if its use is still debated for primary arthroplasties [ 14 , 15 , 16 , 17 ]. In a recent meta-analysis, Sebastian et al reported that antibiotic-loaded bone cements (ALBCs) are effective in reducing PJI following primary total joint arthroplasty, with a reduction in risk of between 20 and 84% [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria

et al. 2022

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Gram-negative bacilli can be responsible for prosthetic joint infection (PJI) even if staphylococci are the main involved pathogens. Gram-negative PJIs (GN-PJI) are considered difficult-to-treat infections due to the increase in antimicrobial resistance and biofilm formation. To minimize the risk of infection in cases of arthroplasties with cemented prosthesis, bone cement can be loaded with antibiotics, especially gentamicin. In this study, we aimed to compare the prophylactic antibiofilm activity of ready-to-use antibiotic-loaded bone cements (ALBC), already commercialized or new prototypes. We compared ALBCs containing gentamicin alone, gentamicin plus vancomycin, gentamicin plus clindamycin, gentamicin plus Fosfomycin, and fosfomycin alone, to plain cement (no antibiotic); these comparisons were conducted to investigate the biofilm formation of three strains of Escherichia coli, three strains of Pseudomonas aeruginosa and two strains of Klebsiella pneumoniae, with or without specific resistance to gentamicin or fosfomycin. We reported that ALBC containing gentamicin and clindamycin (COPAL G+C) seems to be the most interesting ALBC of our tested panel for the prevention of biofilm formation by gentamicin-susceptible strains, even if clindamycin is not effective against Gram-negative bacteria. However, gentamicin-resistant strains are still a problem, and further studies are needed to identify an antibiotic to associate with gentamicin for an efficient dual ALBC against Gram-negative bacteria.

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Section: Introductionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria

et al. 2022

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“…the presence of an implant means that patients have a continuing risk of infection, and following improvements in bearing surfaces, infection is now the most common indicatiion for revision tKA, 31,32 despite the widespread use of prophylactic antibiotics. 33 Causation is rarely established in these situations, butcouldbeinfluencedbyanincreasedcomorbidityprofileas patients age. those considering tKA at younger ages need to becounselledstronglyaboutthesignificanceofrevisionarthroplasty for infection, as 1:10 males and 1:20 females risk having to contend with this potentially life-altering event.…”

Section: Discussionmentioning

confidence: 99%

The lifetime risk of revision following total knee arthroplasty

Stone

Nugent

Young

et al. 2022

The Bone & Joint Journal

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Aims The success of total knee arthroplasty (TKA) is usually measured using functional outcome scores and revision-free survivorship. However, reporting the lifetime risk of revision may be more meaningful to patients when gauging risks, especially in younger patients. We aimed to assess the lifetime risk of revision for patients in different age categories at the time of undergoing primary TKA. Methods The New Zealand Joint Registry database was used to obtain revision rates, mortality, and the indications for revision for all primary TKAs performed during an 18-year period between January 1999 and December 2016. Patients were stratified into age groups at the time of the initial TKA, and the lifetime risk of revision was calculated according to age, sex, and the American Society of Anesthesiologists (ASA) grade. The most common indications for revision were also analyzed for each age group. Results The overall ten-year survival rate was 95.6%. This was lowest in the youngest age group (between 46 and 50 years) and increased sequentially with increasing age. The lifetime risk of requiring revision was 22.4% in those aged between 46 and 50 years at the time of the initial surgery, and decreased linearly with increasing age to 1.15% in those aged between 90 and 95 years at the time of surgery. Higher ASA grades were associated with increased lifetime risk of revision in all age groups. The three commonest indications for revision were aseptic loosening, infection, and unexplained pain. Young males, aged between 46 and 50 years, had the highest lifetime risk of revision (25.2%). Conclusion Lifetime risk of revision may be a more meaningful measure of outcome than implant survival at defined time periods when counselling patients prior to TKA. This study highlights the considerably higher lifetime risk of revision surgery for all indications, including infection, in younger male patients. Cite this article: Bone Joint J 2022;104-B(2):235–241.

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“…Cement brand and viscosity were also not considered, but antibiotic content has not been shown to affect all-cause revision. 26 However, we have collected data that encompass the diversity of implant designs and cement characteristics across routine practice in the UK, and this helps ensure wide generalisability of the results. Another limitation is the relatively small sample size of TKR procedures performed without a tourniquet across a large number of centres (approximately 150 centres) which may have influenced our results due to performance bias and confounding by indication.…”

Section: Discussionmentioning

confidence: 99%

Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set

et al. 2021

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ObjectiveTourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet.DesignWe analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes.ResultsData were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18).ConclusionsWe did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.

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The effect of antibiotic-loaded bone cement on risk of revision following hip and knee arthroplasty

Cited by 24 publications

References 39 publications

Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria

Prophylactic Antibiofilm Activity of Antibiotic-Loaded Bone Cements against Gram-Negative Bacteria

The lifetime risk of revision following total knee arthroplasty

Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set

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