Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement
(2024) In JAMA Network Open 7(5). p.2412898-2412898- 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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2024-05-01
- type
- Contribution to journal
- publication status
- published
- subject
- in
- JAMA Network Open
- volume
- 7
- issue
- 5
- pages
- 2412898 - 2412898
- publisher
- American Medical Association
- external identifiers
-
- scopus:85194026916
- pmid:38780939
- ISSN
- 2574-3805
- DOI
- 10.1001/jamanetworkopen.2024.12898
- language
- English
- LU publication?
- yes
- id
- 14d10e5c-bbb6-435c-8d34-29404bd01017
- date added to LUP
- 2024-05-31 15:22:22
- date last changed
- 2024-06-14 16:08:08
@article{14d10e5c-bbb6-435c-8d34-29404bd01017,
abstract = {{<p>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.</p>}},
author = {{Leta, Tesfaye H. 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 Bülow, Erik and van Steenbergen, Liza N. and Nelissen, Rob G.H.H. and Harries, Dylan and de Steiger, Richard and Lutro, Olav and Mäkelä, Keijo and Venäläinen, Mikko S. and Willis, Jinny and Wyatt, Michael and Frampton, Chris and Grimberg, Alexander and Steinbrück, Arnd and Wu, Yinan and Armaroli, Cristiana and Gentilini, Maria Adalgisa and Picus, Roberto and Bonetti, Mirko and Dragosloveanu, Serban and Vorovenci, Andreea E. and Dragomirescu, Dan and Dale, Håvard and Brand, Christian and Christen, Bernhard and Shapiro, Joanne and Wilkinson, J. Mark and Armstrong, Richard and Wooster, Kate and Hallan, Geir and Gjertsen, Jan Erik and Chang, Richard N. and Prentice, Heather A. and Sedrakyan, Art and Paxton, Elizabeth W. and Furnes, Ove}},
issn = {{2574-3805}},
language = {{eng}},
month = {{05}},
number = {{5}},
pages = {{2412898--2412898}},
publisher = {{American Medical Association}},
series = {{JAMA Network Open}},
title = {{Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement}},
url = {{http://dx.doi.org/10.1001/jamanetworkopen.2024.12898}},
doi = {{10.1001/jamanetworkopen.2024.12898}},
volume = {{7}},
year = {{2024}},
}