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Title: Periprosthetic joint infection after total knee arthroplasty with or without antibiotic bone cement.
Epworth Authors: De Steiger, Richard
Other Authors: Leta, Tesfaye
Lie, Stein Atle
Fenstad, Anne Marie
Lygre, Stein Hakon
Larson, Martin Linberg
Pederson, Alma
Rolfson, Ola
Bulow, Erik
Van Steenbergen, Liza
Nelissen, Rob
Harries, Dylan
Wyatt, Michael
Lutro, Olav
Makela, Keijo
Venäläinen, Mikko
Willis, Jinny
Frampton, Chris
Grimburg, Alexander
Steinbrück, Arnd
Wu, Yinan
Armaroli, Cristiana
Gentilini, Maria
Picus, Roberto
Bonetti, Mirko
Dragosloveanu, Serban
Vorovenci, Andreea
Dragomirescu, Dan
Dale, Havard
Brand, Christian
Christen, Bernhard
Shapiro, Joanne
Wilkinson, Mark
Armstrong, Richard
Wooster, Kate
Hallan, Geir
Gjertsen, Jan-Erik
Chang, Richard
Prentice, Heather
Sedrakyan, Art
Paxton, Elizabeth
Furnes, Ove
Keywords: Aged
Antibacterial Agents
Joint Replacement
Adverse Effects
Prosthesis-Related Infections
Antibiotic-Loaded bone cement
Periprosthetic Joint Infection
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: May-2024
Publisher: AMA
Citation: JAMA Netw Open . 2024 May 1;7(5):e2412898
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.
DOI: 10.1001/jamanetworkopen.2024.12898
PubMed URL:
ISSN: 2574-3805
Journal Title: JAMA Network Open
Type: Journal Article
Affiliated Organisations: The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
Faculty of Health Science, VID Specialized University, Oslo, Norway.
Department of Population Health Sciences, Weill Medical College of Cornell University, New York, New York.
Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California.
Center for Translational Oral Research, Department of Dentistry, University of Bergen, Bergen, Norway.
Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
The Danish Knee Arthroplasty Register, Odense, Denmark.
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
The Swedish Arthroplasty Register, Gothenburg, Sweden.
Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden.
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Centre of Registers Västra Götaland, Gothenburg, Sweden.
The Dutch Arthroplasty Register, 's-Hertogenbosch, the Netherlands.
Department Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands.
South Australian Health and Medical Research Institute, Adelaide, Australia.
The Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia.
Department of Medicine, Stavanger University Hospital, Stavanger, Norway.
The Finnish Arthroplasty Register, Helsinki, Finland.
Turku University Hospital and University of Turku, Turku, Finland.
Department of Medical Physics, Turku University Hospital, Turku, Finland.
The New Zealand Joint Registry, Christchurch, New Zealand.
German Arthroplasty Registry, Berlin, Germany.
Arthroplasty Registry of the Autonomous Province of Trento, Clinical Epidemiology Service, Provincial Agency for Health Services of Trento, Trento, Italy.
Arthroplasty Register of Autonomous Province of Bolzano, Observatory of Health, Health Department AP of Bolzano, Bolzano, Italy
Romanian Arthroplasty Registry, Bucharest, Romania.
University of Medicine and Pharmacy-Carol Davila, Bucharest, Romania.
Foisor Orthopaedic Hospital, Bucharest, Romania.
Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Bucharest, Romania.
Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
Swiss National Hip and Knee Joint Registry, Bern, Switzerland.
Institute of Social and Preventive Medicine, SwissRDL, University of Bern, Bern, Switzerland.
Articon, Bern, Switzerland.
The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, London, United Kingdom.
NEC Software Solutions, Hemel Hempstead, United Kingdom.
Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom.
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Musculoskeletal

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