Clinical Orthopaedics and Related Research®

, Volume 472, Issue 1, pp 162–168 | Cite as

Does Adding Antibiotics to Cement Reduce the Need for Early Revision in Total Knee Arthroplasty?

  • Eric Bohm
  • Naisu Zhu
  • Jing Gu
  • Nicole de Guia
  • Cassandra Linton
  • Tammy Anderson
  • David Paton
  • Michael Dunbar
Symposium: 2013 Knee Society Proceedings

Abstract

Background

There is considerable debate about whether antibiotic-loaded bone cement should be used for fixation of TKAs. While antibiotics offer the theoretical benefit of lowering early revision due to infection, they may weaken the cement and thus increase the likelihood of aseptic loosening, perhaps resulting in a higher revision rate.

Questions/purposes

We (1) compared the frequency of early knee revision arthroplasty in patients treated with antibiotic-loaded or non-antibiotic-loaded cement for initial fixation, (2) determined effects of age, sex, comorbidities, and surgeons’ antibiotic-loaded cement usage patterns on revision rate, and (3) compared causes of revision (aseptic or septic) between groups.

Methods

Our study sample was taken from the Canadian Joint Replacement Registry and Canada’s Hospital Morbidity Database and included cemented TKAs performed between April 1, 2003, and March 31, 2008, including 20,016 TKAs inserted with non-antibiotic-loaded cement and 16,665 inserted with antibiotic-loaded cement. Chi-square test was used to compare the frequency of early revisions between groups. Cox regression modeling was used to determine whether revision rate would change by age, sex, comorbidities, or use of antibiotic-loaded cement. Similar Cox regression modeling was used to compare cause of revision between groups.

Results

Two-year revision rates were similar between the groups treated with non-antibiotic-loaded cement and antibiotic-loaded cement (1.40% versus 1.51%, p = 0.41). When controlling for age, sex, comorbidities, diabetes, and surgeons’ antibiotic-loaded cement usage patterns, the revision risk likewise was similar between groups. Revision rates for infection were similar between groups; however, there were more revisions for aseptic loosening in the group treated with non-antibiotic-loaded cement (p = 0.02).

Conclusions

The use of antibiotic-loaded cement in TKAs performed for osteoarthritis has no clinically significant effect on reducing revision within 2 years in patients who received perioperative antibiotics. Longer followup and confirmation of these findings with other national registries are warranted.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

The authors thank the orthopaedic surgeons, nurses, and secretaries who have contributed to the CJRR.

References

  1. 1.
    Australian Orthopaedic Association. National Joint Replacement Registry Report 2006. Available at: https://aoanjrr.dmac.adelaide.edu.au/documents/10180/75132/Annual%20Report%202006?version=1.1&t=1349406762263. Accessed March 28, 2013.
  2. 2.
    Bohm ER, Dunbar MJ, Frood JJ, Johnson TM, Morris KA. Rehospitalizations, early revisions, infections, and hospital resource use in the first year after hip and knee arthroplasties. J Arthroplasty. 2011;27:232–237.PubMedCrossRefGoogle Scholar
  3. 3.
    Bourne RB. Prophylactic use of antibiotic bone cement: an emerging standard—in the affirmative. J Arthroplasty. 2004;19:69–72.PubMedCrossRefGoogle Scholar
  4. 4.
    Canadian Institute for Health Information. Privacy policy on the collection, use, disclosure and retention of personal health information and de-identified data. Available at: https://secure.cihi.ca/free_products/Privacy%20Policy2013_EN_Web.pdf. Accessed March 28, 2013.
  5. 5.
    Chiu FY, Chen CM, Lin CF, Lo WH. Cefuroxime-impregnated cement in primary total knee arthroplasty: a prospective, randomized study of three hundred and forty knees. J Bone Joint Surg Am. 2002;84:759–762.PubMedGoogle Scholar
  6. 6.
    Department of Orthopedics, Lund University Hospital. The Swedish Knee Arthroplasty Register Annual Report 2010. Available at: http://www.knee.nko.se/english/online/uploadedFiles/114_SKAR2010_Eng1.0.pdf. Accessed March 28, 2013.
  7. 7.
    Dunne N, Hill J, McAfee P, Todd K, Kirkpatrick R, Tunney M, Patrick S. In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: effect on mechanical properties, antibiotic release, and biofilm formation. Acta Orthop. 2007;78:774–785.PubMedCrossRefGoogle Scholar
  8. 8.
    Engesaeter LB, Espehaug B, Lie SA, Furnes O, Havelin LI. Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0–16 years in the Norwegian Arthroplasty Register. Acta Orthop. 2006;77:351–358.PubMedCrossRefGoogle Scholar
  9. 9.
    Engesaeter LB, Lie SA, Espehaug B, Furnes O, Vollset SE, Havelin LI. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0–14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand. 2003;74:644–651.PubMedCrossRefGoogle Scholar
  10. 10.
    Gandhi R, Razak F, Pathy R, Davey JR, Syed K, Mahomed NN. Antibiotic bone cement and the incidence of deep infection after total knee arthroplasty. J Arthroplasty. 2009;24:1015–1018.PubMedCrossRefGoogle Scholar
  11. 11.
    Hanssen AD. Prophylactic use of antibiotic bone cement: an emerging standard—in opposition. J Arthroplasty. 2004;19:73–77.PubMedCrossRefGoogle Scholar
  12. 12.
    Havelin LI, Espehaug B, Vollset SE, Engesaeter LB. The effect of the type of cement on early revision of Charnley total hip prostheses: a review of eight thousand five hundred and seventy-nine primary arthroplasties from the Norwegian Arthroplasty Register. J Bone Joint Surg Am. 1995;77:1543–1550.PubMedGoogle Scholar
  13. 13.
    Jamsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty: a register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91:38–47.PubMedCrossRefGoogle Scholar
  14. 14.
    Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am. 2006;88:2487–2500.PubMedCrossRefGoogle Scholar
  15. 15.
    Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–656.PubMedCrossRefGoogle Scholar
  16. 16.
    Namba RS, Chen Y, Paxton EW, Slipchenko T, Fithian DC. Outcomes of routine use of antibiotic-loaded cement in primary total knee arthroplasty. J Arthroplasty. 2009;24:44–47.PubMedCrossRefGoogle Scholar
  17. 17.
    National Joint Registry for England and Wales. 7th Annual Report 2010. Available at: http://www.njrcentre.org.uk/njrcentre/portals/0/njr 7th annual report 2010.pdf. Accessed March 28, 2013.
  18. 18.
    Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi JC, Saunders LD, Beck CA, Feasby TE, Ghali WA. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43:1130–1139.PubMedCrossRefGoogle Scholar
  19. 19.
    Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res. 2002;20:506–515.PubMedCrossRefGoogle Scholar
  20. 20.
    van de Belt H, Neut D, Schenk W, van Horn JR, van der Mei HC, Busscher HJ. Gentamicin release from polymethylmethacrylate bone cements and Staphylococcus aureus biofilm formation. Acta Orthop Scand. 2000;71:625–629.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Eric Bohm
    • 1
  • Naisu Zhu
    • 2
  • Jing Gu
    • 2
  • Nicole de Guia
    • 2
  • Cassandra Linton
    • 2
  • Tammy Anderson
    • 2
  • David Paton
    • 2
  • Michael Dunbar
    • 3
  1. 1.Concordia Joint Replacement GroupUniversity of ManitobaWinnipegCanada
  2. 2.Canadian Institute for Health InformationTorontoCanada
  3. 3.QEII Health Sciences CentreDalhousie UniversityHalifaxCanada

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