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Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients

Leta, Tesfaye H. ; Chang, Richard N. ; Lie, Stein Atle ; Fenstad, Anne Marie ; Lygre, Stein Håkon L. ; Lindberg-Larsen, Martin ; Pedersen, Alma B. ; W-Dahl, Annette LU ; Rolfson, Ola and Johansson, Oskar , et al. (2025) In JBJS Open Access 10(3).
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... (More)

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.Level of Evidence: – Level III. See Instructions for Authors for a complete description of levels of evidence.

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publication status
published
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JBJS Open Access
volume
10
issue
3
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:105026578165
  • pmid:40978005
ISSN
2472-7245
DOI
10.2106/JBJS.OA.25.00061
language
English
LU publication?
yes
id
cb0c6837-d944-4aa2-9e56-90d9d7023834
date added to LUP
2026-02-16 12:53:28
date last changed
2026-07-08 12:39:59
@article{cb0c6837-d944-4aa2-9e56-90d9d7023834,
  abstract     = {{<p>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.Level of Evidence: – Level III. See Instructions for Authors for a complete description of levels of evidence.</p>}},
  author       = {{Leta, Tesfaye H. and Chang, Richard N. and Lie, Stein Atle and Fenstad, Anne Marie and Lygre, Stein Håkon L. and Lindberg-Larsen, Martin and Pedersen, Alma B. and W-Dahl, Annette and Rolfson, Ola and Johansson, Oskar and van Steenbergen, Liza N. and Nelissen, Rob GHH and Harries, Dylan and Holder, Carl and Lewis, Peter and de Steiger, Richard and Lutro, Olav and Mäkelä, Keijo and Venäläinen, Mikko S. and Willis, Jinny and Frampton, Chris and Wyatt, Michael and Grimberg, Alexander and Steinbrück, Arnd and Wu, Yinan and Dale, Håvard and Brand, Christian and Christen, Bernhard and Shapiro, Joanne and Wilkinson, J. Mark and Edwards, Morgan and Hallan, Geir and Gjertsen, Jan Erik and Furnes, Ove and Sedrakyan, Art and Prentice, Heather A. and Paxton, Elizabeth W.}},
  issn         = {{2472-7245}},
  language     = {{eng}},
  number       = {{3}},
  publisher    = {{Lippincott Williams & Wilkins}},
  series       = {{JBJS Open Access}},
  title        = {{Antibiotic-Loaded Bone Cement and Risk of Infection After Knee Arthroplasty in High-Risk Patients}},
  url          = {{http://dx.doi.org/10.2106/JBJS.OA.25.00061}},
  doi          = {{10.2106/JBJS.OA.25.00061}},
  volume       = {{10}},
  year         = {{2025}},
}