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Local antibiotics in primary hip and knee arthroplasty: a systematic review and meta-analysis

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Infection is a truly devastating complication of total joint arthroplasty, causing most patients to undergo a revision surgery, and to bear significant psychological and financial burden. The purpose of this study is to systematically evaluate the literature to determine the efficacy and complication profile of local antibiotic application in primary total joint arthroplasty.

Methods

All studies of primary total joint arthroplasty which assessed local antibiotics in any form other than antibiotic-impregnated cement as an intervention were included. Studies that reported at least one outcome related to infection and were available in full text in English were eligible for inclusion. Studies which included both primary and revision cases but did not report the stratified data for each type of surgery and studies on fracture populations were excluded.

Results

A total of 9 studies involving 3,714 cases were included. The pooled deep infection rate was 1.6% in the intervention groups and 3.5% in the control groups. Meta-analysis revealed a RR of 0.53 (95%CI: 0.35–0.79, p = 0.002) with no heterogeneity (I2 = 0%) for infection in the intervention groups. Meta-analysis revealed a non-significant reduction in superficial infection rates in the intervention groups; however, there was a significant increase in aseptic wound complications in the intervention groups.

Conclusion

Local antibiotic application results in a moderate reduction in deep infection rates in primary total joint arthroplasty, with no significant impact on superficial infection rates. However, local antibiotic application may be associated with a moderate increase in aseptic wound complications.

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, St. Joseph’s Hospital, McMaster University, 50 Charlton Avenue East, Room G522, Hamilton, ON, L8N 4A6, Canada

    Ahmed Saidahmed, Mohamed Sarraj, Seper Ekhtiari, Daniel Tushinski, Thomas J. Wood & Mohit Bhandari

  2. Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Raman Mundi

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  1. Ahmed Saidahmed
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  2. Mohamed Sarraj
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  3. Seper Ekhtiari
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Corresponding author

Correspondence to Ahmed Saidahmed.

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Conflicts of interest

Author Mohit Bhandari is a consultant for Sanofi, Pendopharm, and Ferring Pharmaceuticals, and received research grants from Sanofi, Ferring Pharmaceuticals, DJ Orthopedics, Acumed, Anika Therapeutics, and Flexion Therapeutics. Other authors have no conflict of interest to disclose. No funds were received in support of this study.

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Appendices

Appendix 1: Eligibility criteria

1. Inclusion criteria

2. Adult population

3. All primary surgical techniques (no revision)

4. Clinical outcomes reported

5. Human Studies

6. Total knee and hip arthroplasty only

7. Prophylactic local antibiotics in non-infected joint

Exclusion criteria

1. Inverse of inclusion criteria

2. Review, technical, anatomic, pharmacologic, or otherwise non-prognostic articles

3. Use of antibiotic impregnated cement

4. Non-English studies

5. Population >10% with previous surgery to joint of interest

Appendix 2: Full search strategy. Search Date: November 3, 2019

Embase (1534)

Medline1(979)

1. exp hip arthroplasty/ or exp knee arthroplasty/ or exp arthroplasty/ or exp total knee arthroplasty/ or exp replacement arthroplasty/ or exp total arthroplasty/ or ("total hip" or "total knee").ti,ab,kw.

2. (bacter* or antibio*).ti,ab,kw. or exp antibiotic agent/

3. ("local" or regional* or powder* or topical* or tissue*).ti,ab,kw.

4. 1 and 2 and 3

1. Arthroplasty, Replacement, Knee/ or Arthroplasty, Replacement, Hip/ or ("total hip" or "total knee").ti,ab,kf.

2. exp Anti-Bacterial Agents/ (bacter* or antib*).ti,ab,kf.

3. ("local" or region* or topical* or powder* or wound* or tissue*).ti,ab,kf.

4. 1 and 2 and 3

  1. 1.

    OVID Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present

Web of Science (8)

TOPIC: (TOPIC: (("total hip" or "total knee")) AND TOPIC: ((antibact* or antibiot*)) AND TOPIC: ((local* or topical* or tissue* or regional*)))

Timespan: All years.

Indexes: SCI-EXPANDED.

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Saidahmed, A., Sarraj, M., Ekhtiari, S. et al. Local antibiotics in primary hip and knee arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 31, 669–681 (2021). https://doi.org/10.1007/s00590-020-02809-w

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  • DOI: https://doi.org/10.1007/s00590-020-02809-w

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