Jameson, Simon S., Asaad, Asaad, Diament, Marina, Kasim, Adetatyo, Bigirumurame, Theophile, Baker, Paul, Mason, James, Partington, Paul and Reed, Mike (2019) Antibiotic-loaded bone cement is associated with a lower risk of revision following primary cemented total knee arthroplasty. The Bone & Joint Journal, 101-B (11). pp. 1331-1347. doi:10.1302/0301-620X.101B11.BJJ-2019-0196.R1 ISSN 2049-4394.

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Abstract

Aims
Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients.

Materials and Methods
Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients.

Results
Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group.

Conclusion
After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates.

Item Type:	Journal Article
Subjects:	R Medicine > RD Surgery R Medicine > RM Therapeutics. Pharmacology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Bone cements, Artificial joints -- Infections, Total knee replacement , Prosthesis -- Complications, Antibiotics
Journal or Publication Title:	The Bone & Joint Journal
Publisher:	British Editorial Society of Bone and Joint Surgery
ISSN:	2049-4394
Official Date:	1 November 2019
Dates:	Date Event 1 November 2019 Available 1 November 2019 Published 1 November 2019 Accepted
Volume:	101-B
Number:	11
Page Range:	pp. 1331-1347
DOI:	10.1302/0301-620X.101B11.BJJ-2019-0196.R1
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Copyright Holders:	©2019 The British Editorial Society of Bone & Joint Surgery
Date of first compliant deposit:	6 November 2019
Date of first compliant Open Access:	1 November 2020

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