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Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement. 2024
Tesfaye H Leta, and
Stein Atle Lie, and
Anne Marie Fenstad, and
Stein Håkon L Lygre, and
Martin Lindberg-Larsen, and
Alma B Pedersen, and
Annette W-Dahl, and
Ola Rolfson, and
Erik Bülow, and
Liza N van Steenbergen, and
Rob G H H Nelissen, and
Dylan Harries, and
Richard de Steiger, and
Olav Lutro, and
Keijo Mäkelä, and
Mikko S Venäläinen, and
Jinny Willis, and
Michael Wyatt, and
Chris Frampton, and
Alexander Grimberg, and
Arnd Steinbrück, and
Yinan Wu, and
Cristiana Armaroli, and
Maria Adalgisa Gentilini, and
Roberto Picus, and
Mirko Bonetti, and
Serban Dragosloveanu, and
Andreea E Vorovenci, and
Dan Dragomirescu, and
Håvard Dale, and
Christian Brand, and
Bernhard Christen, and
Joanne Shapiro, and
J Mark Wilkinson, and
Richard Armstrong, and
Kate Wooster, and
Geir Hallan, and
Jan-Erik Gjertsen, and
Richard N Chang, and
Heather A Prentice, and
Art Sedrakyan, and
Elizabeth W Paxton, and
Ove Furnes
The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
Despite 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. To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. This 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. Primary TKA with ALBC vs plain bone cement. The 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. Among 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. In 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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