Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis
Background:. The use of systemic antibiotic prophylaxis (SAP) and antibiotic-loaded bone cement (ALBC) is the accepted practice to reduce the risk of periprosthetic joint infection (PJI) in primary total knee arthroplasty (pTKA). However, practice varies internationally. This study's primary ai...
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Wolters Kluwer
2024-12-01
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| Series: | JBJS Open Access |
| Online Access: | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00140 |
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| author | Tesfaye H. Leta, PhD Richard N. Chang, MPH Anne Marie Fenstad, MSc Stein Atle Lie, PhD Stein Håkon L. Lygre, PhD Martin Lindberg-Larsen, PhD Alma B. Pedersen, PhD Olav Lutro, MD Jinny Willis, PhD Chris Frampton, PhD Michael Wyatt, MD Serban Dragosloveanu, MD Andreea E. Vorovenci, MSc Dan Dragomirescu, MSc Håvard Dale, PhD Geir Hallan, PhD Jan-Erik Gjertsen, PhD Heather A. Prentice, PhD Ove Furnes, PhD Art Sedrakyan, PhD Elizabeth W. Paxton, PhD |
| author_facet | Tesfaye H. Leta, PhD Richard N. Chang, MPH Anne Marie Fenstad, MSc Stein Atle Lie, PhD Stein Håkon L. Lygre, PhD Martin Lindberg-Larsen, PhD Alma B. Pedersen, PhD Olav Lutro, MD Jinny Willis, PhD Chris Frampton, PhD Michael Wyatt, MD Serban Dragosloveanu, MD Andreea E. Vorovenci, MSc Dan Dragomirescu, MSc Håvard Dale, PhD Geir Hallan, PhD Jan-Erik Gjertsen, PhD Heather A. Prentice, PhD Ove Furnes, PhD Art Sedrakyan, PhD Elizabeth W. Paxton, PhD |
| author_sort | Tesfaye H. Leta, PhD |
| collection | DOAJ |
| description | Background:. The use of systemic antibiotic prophylaxis (SAP) and antibiotic-loaded bone cement (ALBC) is the accepted practice to reduce the risk of periprosthetic joint infection (PJI) in primary total knee arthroplasty (pTKA). However, practice varies internationally. This study's primary aim was to compare the risk of PJI revision after pTKA with ALBC + SAP vs. plain bone cement (PBC) + SAP, and the secondary aim was to assess whether the risk of PJI revision varies with the number of SAP doses.
Methods:. Cohort of 289,926 pTKAs for osteoarthritis from arthroplasty registries in Denmark, New Zealand, Norway, Romania, and United States registered from 2010 to 2020. One-year revision for PJI following pTKA with ALBC + SAP vs. PBC + SAP, and single vs. multiple SAP doses was compared. We computed cumulative percent revision (1 minus Kaplan-Meier) using distributed analysis method and adjusted hazard rate ratios (HRRs) using Cox regression analyses within each registry. Advanced distributed meta-analysis was performed to summarize HRRs from all countries.
Results:. Among all pTKAs, 64.4% were performed with ALBC + SAP. Each registry reported a 1-year cumulative percent revision for PJI of <1.00% for both pTKAs with ALBC + SAP (0.34%-0.80%) and with PBC + SAP (0.54%-0.69%). The distributed meta-analysis showed HRR = 1.21; (95% confidence interval [CI], 0.79-1.87) for ALBC + SAP compared with PBC + SAP. Similar risk of PJI revision was observed between pTKAs with ALBC + single vs. multiple doses of SAP: 2 doses (0.95; 95% CI, 0.68-1.33), 3 doses (1.09; 95% CI, 0.64-1.87), and 4 doses (1.23; 95% CI, 0.69-2.21). Comparable results were found for the PBC + SAP group except for higher risk of PJI revision with 4 doses of SAP (2.74; 95% CI, 1.11-6.75).
Conclusions:. ALBC and PBC entailed similar risk of PJI revision when patients received SAP in pTKA, regardless of number of SAP doses. ALBC or PBC used in combination with SAP in pTKAs, with one single preoperative dose of SAP may be sufficient without compromising the patient safety.
Level of evidence:. Level III. See Instructions for Authors for a complete description of levels of evidence. |
| format | Article |
| id | doaj-art-bcd1aa985011484a956db7fca041d8d6 |
| institution | OA Journals |
| issn | 2472-7245 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | JBJS Open Access |
| spelling | doaj-art-bcd1aa985011484a956db7fca041d8d62025-08-20T02:00:02ZengWolters KluwerJBJS Open Access2472-72452024-12-019410.2106/JBJS.OA.24.00140JBJSOA2400140Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-AnalysisTesfaye H. Leta, PhD0Richard N. Chang, MPH1Anne Marie Fenstad, MSc2Stein Atle Lie, PhD3Stein Håkon L. Lygre, PhD4Martin Lindberg-Larsen, PhD5Alma B. Pedersen, PhD6Olav Lutro, MD7Jinny Willis, PhD8Chris Frampton, PhD9Michael Wyatt, MD10Serban Dragosloveanu, MD11Andreea E. Vorovenci, MSc12Dan Dragomirescu, MSc13Håvard Dale, PhD14Geir Hallan, PhD15Jan-Erik Gjertsen, PhD16Heather A. Prentice, PhD17Ove Furnes, PhD18Art Sedrakyan, PhD19Elizabeth W. Paxton, PhD201 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway4 Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway7 The Danish Knee Arthroplasty Register, Odense, Denmark7 The Danish Knee Arthroplasty Register, Odense, Denmark10 Department of Medicine, Stavanger University Hospital, Stavanger, Norway11 The New Zealand Joint Registry, Christchurch, New Zealand11 The New Zealand Joint Registry, Christchurch, New Zealand11 The New Zealand Joint Registry, Christchurch, New Zealand12 Romanian Arthroplasty Registry, Bucharest, Romania12 Romanian Arthroplasty Registry, Bucharest, Romania12 Romanian Arthroplasty Registry, Bucharest, Romania1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway4 Medical Device Surveillance & Assessment, Kaiser Permanente, San Diego1 The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway3 Department of Population Health Science, Weill Medical College of Cornell University, New York4 Medical Device Surveillance & Assessment, Kaiser Permanente, San DiegoBackground:. The use of systemic antibiotic prophylaxis (SAP) and antibiotic-loaded bone cement (ALBC) is the accepted practice to reduce the risk of periprosthetic joint infection (PJI) in primary total knee arthroplasty (pTKA). However, practice varies internationally. This study's primary aim was to compare the risk of PJI revision after pTKA with ALBC + SAP vs. plain bone cement (PBC) + SAP, and the secondary aim was to assess whether the risk of PJI revision varies with the number of SAP doses. Methods:. Cohort of 289,926 pTKAs for osteoarthritis from arthroplasty registries in Denmark, New Zealand, Norway, Romania, and United States registered from 2010 to 2020. One-year revision for PJI following pTKA with ALBC + SAP vs. PBC + SAP, and single vs. multiple SAP doses was compared. We computed cumulative percent revision (1 minus Kaplan-Meier) using distributed analysis method and adjusted hazard rate ratios (HRRs) using Cox regression analyses within each registry. Advanced distributed meta-analysis was performed to summarize HRRs from all countries. Results:. Among all pTKAs, 64.4% were performed with ALBC + SAP. Each registry reported a 1-year cumulative percent revision for PJI of <1.00% for both pTKAs with ALBC + SAP (0.34%-0.80%) and with PBC + SAP (0.54%-0.69%). The distributed meta-analysis showed HRR = 1.21; (95% confidence interval [CI], 0.79-1.87) for ALBC + SAP compared with PBC + SAP. Similar risk of PJI revision was observed between pTKAs with ALBC + single vs. multiple doses of SAP: 2 doses (0.95; 95% CI, 0.68-1.33), 3 doses (1.09; 95% CI, 0.64-1.87), and 4 doses (1.23; 95% CI, 0.69-2.21). Comparable results were found for the PBC + SAP group except for higher risk of PJI revision with 4 doses of SAP (2.74; 95% CI, 1.11-6.75). Conclusions:. ALBC and PBC entailed similar risk of PJI revision when patients received SAP in pTKA, regardless of number of SAP doses. ALBC or PBC used in combination with SAP in pTKAs, with one single preoperative dose of SAP may be sufficient without compromising the patient safety. Level of evidence:. Level III. See Instructions for Authors for a complete description of levels of evidence.http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00140 |
| spellingShingle | Tesfaye H. Leta, PhD Richard N. Chang, MPH Anne Marie Fenstad, MSc Stein Atle Lie, PhD Stein Håkon L. Lygre, PhD Martin Lindberg-Larsen, PhD Alma B. Pedersen, PhD Olav Lutro, MD Jinny Willis, PhD Chris Frampton, PhD Michael Wyatt, MD Serban Dragosloveanu, MD Andreea E. Vorovenci, MSc Dan Dragomirescu, MSc Håvard Dale, PhD Geir Hallan, PhD Jan-Erik Gjertsen, PhD Heather A. Prentice, PhD Ove Furnes, PhD Art Sedrakyan, PhD Elizabeth W. Paxton, PhD Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis JBJS Open Access |
| title | Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis |
| title_full | Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis |
| title_fullStr | Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis |
| title_full_unstemmed | Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis |
| title_short | Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis |
| title_sort | number of doses of systemic antibiotic prophylaxis may be reduced in cemented primary knee arthroplasty irrespective of use of antibiotic in the cement a multiregistry based meta analysis |
| url | http://journals.lww.com/jbjsoa/fulltext/10.2106/JBJS.OA.24.00140 |
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