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.
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.
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.
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).
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.
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The authors thank the orthopaedic surgeons, nurses, and secretaries who have contributed to the CJRR.
The institution of one or more of the authors (EB, MD) has received, during the study period, funding from Stryker Orthopaedics (Mahwah, NJ, USA), Zimmer, Inc (Warsaw, IN, USA), DePuy Orthopaedics, Inc (Warsaw, IN, USA), and Smith & Nephew, Inc (Memphis, TN, USA). One of the authors certifies that he (MD), or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker. One or more authors (NZ, JG, NG, CL, TA) is an employee of the Canadian Institute of Health Information.
All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.
Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
Data were obtained from the national Canadian Joint Replacement Registry and analysis was performed at Canadian Institute for Health Information (Toronto and Ottawa, Ontario, Canada), Concordia Joint Replacement Group (Winnipeg, Manitoba, Canada), and Dalhousie University (Halifax, Nova Scotia, Canada).
The opinions expressed in this article are those of the authors and do not necessarily represent the views of the Canadian Institute for Health Information.
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Bohm, E., Zhu, N., Gu, J. et al. Does Adding Antibiotics to Cement Reduce the Need for Early Revision in Total Knee Arthroplasty?. Clin Orthop Relat Res 472, 162–168 (2014). https://doi.org/10.1007/s11999-013-3186-1
- Aseptic Loosening
- Revision Rate
- Cement Type
- Early Revision