http://hdl.handle.net/11434/5 Sat, 18 Apr 2026 00:23:14 GMT 2026-04-18T00:23:14Z http://hdl.handle.net/11434/2398 Title: Fifteen-year mortality following periprosthetic joint infection in total knee arthroplasty: A registry study of 8,642 revisions for infection. Epworth Authors: de Steiger, Richard Abstract: Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with notable loss of function, impaired quality of life, and excess short-term mortality. In this study, we aimed to report the impact of PJI on long-term mortality and its associated risk factors. Methods: Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), we used Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables to describe mortality rates following revision for PJI, aseptic revisions (excluding those for fracture), and unrevised primary TKA. Additionally, hazard ratios (HRs) were calculated with multivariable proportional hazard models to assess the impact of the risk factors of age, gender, comorbidities, and minor versus major revisions. Results: Among 867,113 TKA procedures overall, there were 8,642 first revisions for PJI and 25,328 aseptic first revisions. At 5, 10, and 15 years, 16.1%, 34.4%, and 53.4% of patients with revision for PJI had died. When compared with a matched population, the SMR for revision for PJI was 1.33 (95% confidence interval [CI]: 1.28 to 1.39); for aseptic revision, 0.84 (95% CI: 0.82 to 0.87); and for unrevised primary TKA, 0.79 (95% CI: 0.78 to 0.79). Increasing age and higher American Society of Anesthesiologists (ASA) scores were significant mortality risk factors. Major revisions for PJI were not associated with a greater mortality risk compared with minor revisions for PJI. Conclusions: Patients with revision for PJI had a 33% greater-than-expected mortality. There was a high mortality in the early postoperative period, and the excess mortality risk persisted beyond 15 years. Increasing age and higher ASA scores were associated with increased mortality. Fri, 01 Aug 2025 00:00:00 GMT http://hdl.handle.net/11434/2398 2025-08-01T00:00:00Z http://hdl.handle.net/11434/2396 Title: Antibiotic-loaded bone cement and risk of infection after knee arthroplasty in high-risk patients: A register-based meta-analysis. Epworth Authors: de Steiger, Richard Abstract: Background: The use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is debated. Some argue that ALBC might only be justified in high-risk patients. This study assessed the effectiveness of ALBC vs. plain bone cement (PBC) in reducing risk of revision for periprosthetic joint infection (PJI) in TKA patients considered to have a high risk of infection. Methods: Cohort study of primary TKAs in 11 national or regional arthroplasty registries from 2010 to 2020. The 1-year risk of revision for PJI in TKAs with ALBC vs. PBC among patients with high American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and/or diabetes was compared. Cumulative percent revision (1 minus Kaplan-Meier) based on 685,818 TKAs and Cox regression analyses (adjusted Hazard Rate Ratios [aHRRs]) were performed for TKAs with ALBC (reference) vs. PBC restricted to the following high-risk subgroups of patients: (1) ASA ≥3 (n = 335,612 vs. 35,997), (2) BMI ≥35 (n = 278,927 vs. 24,737), (3) ASA ≥3 and BMI ≥35 (n = 99,407 vs. 11,407), (4) diabetes (n = 38,341 vs. 21,838), and (5) ASA ≥3, BMI ≥35, and diabetes (n = 3,347 vs. 4,261). Advanced distributed meta-analyses were performed to combine all aggregate data and assess 1-year risk of revision for PJI. Results: Each registry reported a 1-year cumulative percent revision of ≤1.6% for PJI following TKAs both for ALBC and PBC in all high-risk subgroups. Similar 1-year risks of revision for PJI were found in TKAs with ALBC (reference) and PBC among patients with ASA ≥3 (aHRR: 1.09; 95% CI, 0.90-1.31); BMI ≥35 (1.06; 0.54-2.12); ASA ≥3 and BMI ≥35 (1.12; 0.83-1.50); diabetes (0.95; 0.74-1.20); and ASA ≥3, BMI ≥35, and diabetes (1.40; 0.86-2.29). Conclusions and Relevance: Similar 1-year revision risk of PJI was found for TKAs with ALBC vs. PBC in high-risk patients. Confirmation of the efficacy of ALBC in high-risk TKA patients needs to be evaluated in clinical trials. Mon, 01 Sep 2025 00:00:00 GMT http://hdl.handle.net/11434/2396 2025-09-01T00:00:00Z http://hdl.handle.net/11434/2320 Title: Is there a threshold limit for body mass index for patients undergoing primary total knee or total hip arthroplasty? World Expert Meeting in Arthroplasty 2024. Epworth Authors: De Steiger, Richard Abstract: Is There a Threshold Limit for Body Mass Index for Patients Undergoing Primary Total Knee or Total Hip Arthroplasty? Response/Recommendation: Although most studies show a higher complication rate in patients who have a higher body mass index (BMI), we are unable to determine an exact threshold for BMI in patients undergoing primary total joint arthroplasty (TJA). Level of Evidence: Moderate. Expert Vote: Agree (77.8%), Disagree (13.7%), Abstain (8.5%). Tue, 01 Oct 2024 00:00:00 GMT http://hdl.handle.net/11434/2320 2024-10-01T00:00:00Z http://hdl.handle.net/11434/2296 Title: Periprosthetic joint infection after total knee arthroplasty with or without antibiotic bone cement. Epworth Authors: De Steiger, Richard Abstract: Importance: 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. Objective: To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. Design, setting, and participants: 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. Exposure: Primary TKA with ALBC vs plain bone cement. Main outcomes and measures: 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. Results: 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. Conclusions and relevance: 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. Wed, 01 May 2024 00:00:00 GMT http://hdl.handle.net/11434/2296 2024-05-01T00:00:00Z