The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania

Authors

  • Tesfaye H Leta The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Faculty of Health Science, VID Specialized University, Norway; Department of Population Health Sciences, Weill Medical College of Cornell University, USA; Department of Medical Device Surveillance & Assessment, Kaiser Permanente, USA
  • Anne Marie Fenstad The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway https://orcid.org/0000-0002-6429-0153
  • Stein Håkon L Lygre The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Occupational Medicine, Haukeland University Hospital, Norway
  • Stein Atle Lie The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Institutes of Dentistry, University of Bergen, Norway
  • Martin Lindberg-Larsen The Danish Knee Arthroplasty Register, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark https://orcid.org/0000-0002-4483-677X
  • Alma B Pedersen The Danish Knee Arthroplasty Register, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark https://orcid.org/0000-0002-3288-9401
  • Annette W-Dahl The Swedish Arthroplasty Register, Sweden; Department of Clinical Sciences Lund, Division of Orthopedics, Lund University, Lund, Sweden https://orcid.org/0000-0003-4053-7358
  • Ola Rolfson The Swedish Arthroplasty Register, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden https://orcid.org/0000-0001-6534-1242
  • Erik Bülow Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre of Registers Västra Götaland, Gothenburg, Sweden https://orcid.org/0000-0002-9973-456X
  • James A Ashforth JointCare Registry, South Africa
  • Liza N van Steenbergen The Dutch Arthroplasty Register, the Netherlands https://orcid.org/0000-0002-8141-842X
  • Rob G H H Nelissen The Dutch Arthroplasty Register, the Netherlands; Department of Orthopedics, Leiden University Medical Center, the Netherlands https://orcid.org/0000-0003-1228-4162
  • Dylan Harries South Australian Health and Medical Research Institute, Australia
  • Richard De Steiger The Australian Orthopaedic Association National Joint Replacement Registry, Australia https://orcid.org/0000-0002-1276-2040
  • Olav Lutro Department of Medicine, Stavanger University Hospital, Norway https://orcid.org/0000-0003-3312-3712
  • Emmi Hakulinen The Finnish Institute for Health and Welfare, Finland
  • Keijo Mäkelä The Finnish Arthroplasty Register, Finland; Turku University Hospital and University of Turku, Turku, Finland
  • Jinny Willis The New Zealand Joint Registry, New Zealand
  • Michael Wyatt The New Zealand Joint Registry, New Zealand https://orcid.org/0000-0001-5283-2608
  • Chris Frampton The New Zealand Joint Registry, New Zealand
  • Alexander Grimberg The Germany Arthroplasty Registry, Germany https://orcid.org/0000-0001-8062-788X
  • Arnd Steinbrück The Germany Arthroplasty Registry, Germany
  • Yinan Wu The Germany Arthroplasty Registry, Germany
  • Cristiana Armaroli Arthroplasty Registry of the Autonomous Province of Trento (PATN), Clinical Epidemiology Service, Provincial Agency for Health Services of Trento (APSS), Italy
  • Marco Molinari Orthopedics and Traumatology Operative Unit, Cavalese Hospital, Provincial Agency for Health Services of Trento (APSS), Italy
  • Roberto Picus Arthroplasty Register of Autonomous Province of Bolzano (PABZ), Observatory of Health, Health Department AP of Bolzano, Italy
  • Kyle Mullen American Joint Replacement Registry, USA
  • Richard Illgen American Joint Replacement Registry, USA; University of Wisconsin-Madison School of Medicine and Public Health, Department of Orthopedic Surgery and Rehabilitation, USA
  • Ioan C Stoica Romanian Arthroplasty Registry, Romania; University of Medicine and Pharmacy – Carol Davila – Bucharest – UMFCD Bucharest, Romania; Foisor Orthopedic Hospital, Romania
  • Andreea E Vorovenci Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania
  • Dan Dragomirescu Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania
  • Håvard Dale The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
  • Christian Brand Swiss National Hip & Knee Joint Registry, Switzerland; Institute of Social and Preventive Medicine, SwissRDL, University of Bern; Switzerland
  • Bernhard Christen Swiss National Hip & Knee Joint Registry, Switzerland; Articon, Bern, Switzerland
  • Joanne Shapiro The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
  • J Mark Wilkinson The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
  • Richard Armstrong The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
  • Kate Wooster The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK
  • Geir Hallan The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
  • Jan-Erik Gjertsen The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway https://orcid.org/0000-0002-8490-268X
  • Richard N Chang Medical Device Surveillance & Assessment, Kaiser Permanente, USA
  • Heather A Prentice Medical Device Surveillance & Assessment, Kaiser Permanente, USA https://orcid.org/0000-0002-2200-6564
  • Elizabeth W Paxton Medical Device Surveillance & Assessment, Kaiser Permanente, USA
  • Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway https://orcid.org/0000-0001-8223-2515

DOI:

https://doi.org/10.2340/17453674.2023.17737

Keywords:

Antibitic-loaded bone cement, Arthroplasty, Implants, Joint arthroplasty registry, Knee, Systemic antbiotic prophylactic

Abstract

Background and purpose: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA).
Patients and methods: This observational study is based on 2,971,357 primary TKAs reported in 2010–2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries.
Results: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register).
Conclusion: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.

Downloads

Download data is not yet available.

References

Randelli P, Evola F R, Cabitza P, Polli L, Denti M, Vaienti L. Prophylactic use of antibiotic-loaded bone cement in primary total knee replacement. Knee Surg Sports Traumatol Arthrosc 2010; 18: 181-6. doi: 10.1007/s00167-009-0921-y. DOI: https://doi.org/10.1007/s00167-009-0921-y

Shepard J, Ward W, Milstone A, Carlson T, Frederick J, Hadhazy E, et al. Financial impact of surgical site infections on hospitals: the hospital management perspective. JAMA Surg 2013; 148: 907-14. doi: 10.1001/jamasurg.2013.2246. DOI: https://doi.org/10.1001/jamasurg.2013.2246

Dyrhovden G S, Lygre S H L, Badawy M, Gothesen O, Furnes O. Have the causes of revision for total and unicompartmental knee arthroplasties changed during the past two decades? Clin Orthop Relat Res 2017; 475: 1874-86. doi: 10.1007/s11999-017-5316-7. DOI: https://doi.org/10.1007/s11999-017-5316-7

Bozzo A, Ekhtiari S, Madden K, Bhandari M, Ghert M, Khanna V, et al. Incidence and predictors of prosthetic joint infection following primary total knee arthroplasty: a 15-year population-based cohort study. J Arthroplasty 2022; 37: 367-72.e361. doi: 10.1016/j.arth.2021.10.006. DOI: https://doi.org/10.1016/j.arth.2021.10.006

Buchholz H, Elson R, Engelbrecht E, Lodenkamper H, Rottger J, Siegel A. Management of deep infection of total hip replacement. J Bone Joint Surg Br 1981; 63: 342-53. doi: 10.1302/0301-620X.63B3.7021561. DOI: https://doi.org/10.1302/0301-620X.63B3.7021561

Buchholz H W, Engelbrecht H. [Depot effects of various antibiotics mixed with Palacos resins]. Chirurg 1970; 41: 511-15.

Ekhtiari S, Wood T, Mundi R, Axelrod D, Khanna V, Adili A, et al. Antibiotic cement in arthroplasty: a meta-analysis of randomized controlled trials. Cureus 2020; 12: e7893. doi: 10.7759/cureus.7893. DOI: https://doi.org/10.7759/cureus.7893

Saidahmed A, Sarraj M, Ekhtiari S, Mundi R, Tushinski D, Wood T J, et al. Local antibiotics in primary hip and knee arthroplasty: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2021; 31: 669-81. doi: 10.1007/s00590-020-02809-w. DOI: https://doi.org/10.1007/s00590-020-02809-w

Thornley P, Evaniew N, Riediger M, Winemaker M, Bhandari M, Ghert M. Postoperative antibiotic prophylaxis in total hip and knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. CMAJ Open 2015; 3: E338-43. doi: 10.9778/cmajo.20150012. DOI: https://doi.org/10.9778/cmajo.20150012

Morris A M, Gollish J. Arthroplasty and postoperative antimicrobial prophylaxis. CMAJ 2016; 188: 243-4. doi: 10.1503/cmaj.150429. DOI: https://doi.org/10.1503/cmaj.150429

de Beer J, Petruccelli D, Rotstein C, Weening B, Royston K, Winemaker M. Antibiotic prophylaxis for total joint replacement surgery: results of a survey of Canadian orthopedic surgeons. Can J Surg 2009; 52: E229-34.

Veltman E S, Lenguerrand E, Moojen D J F, Whitehouse M R, Nelissen R G, Blom A W, et al. Similar risk of complete revision for infection with single-dose versus multiple-dose antibiotic prophylaxis in primary arthroplasty of the hip and knee: results of an observational cohort study in the Dutch Arthroplasty Register in 242,179 patients. Acta Orthop 2020; 91: 794-800. doi: 10.1080/17453674.2020.1794096. DOI: https://doi.org/10.1080/17453674.2020.1794096

Von Elm E, Altman D G, Egger M, Pocock S J, Gøtzsche P C, Vandenbroucke J P. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453-7. doi: 10.1016/S0140-6736(07)61602-X. DOI: https://doi.org/10.1016/S0140-6736(07)61602-X

Cafri G, Banerjee S, Sedrakyan A, Paxton L, Furnes O, Graves S, et al. Meta-analysis of survival curve data using distributed health data networks: application to hip arthroplasty studies of the International Consortium of Orthopaedic Registries. Res Synth Methods 2015; 6: 347-56. doi: 10.1002/jrsm.1159. DOI: https://doi.org/10.1002/jrsm.1159

Chan J J, Robinson J, Poeran J, Huang H-H, Moucha C S, Chen D D. Antibiotic-loaded bone cement in primary total knee arthroplasty: utilization patterns and impact on complications using a national database. J Arthroplasty 2019; 34: S188-S194.e181. doi: 10.1016/j.arth.2019.03.006. DOI: https://doi.org/10.1016/j.arth.2019.03.006

Espehaug B, Furnes O, Havelin L, Engesaeter L, Vollset S. The type of cement and failure of total hip replacements. J Bone Joint Surg Br 2002; 84: 832-8. doi: 10.1302/0301-620x.84b6.12776. DOI: https://doi.org/10.1302/0301-620X.84B6.0840832

Wyatt R W B, Chang R N, Royse K E, Paxton E W, Namba R S, Prentice H A. The association between cement viscosity and revision risk after primary total knee arthroplasty. J Arthroplasty 2021; 36(6):1987-94. doi: 10.1016/j.arth.2021.01.052. DOI: https://doi.org/10.1016/j.arth.2021.01.052

Zhang J, Zhang X Y, Jiang F L, Wu Y P, Yang B B, Liu Z Y, et al. Antibiotic-impregnated bone cement for preventing infection in patients receiving primary total hip and knee arthroplasty: a meta-analysis. Medicine 2019; 98. doi: 10.1097/MD.0000000000018068. DOI: https://doi.org/10.1097/MD.0000000000018068

Hinarejos P, Guirro P, Leal J, Montserrat F, Pelfort X, Sorli M, et al. The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am 2013; 95: 769-74. doi: 10.2106/JBJS.L.00901. PMID: 23636182. DOI: https://doi.org/10.2106/JBJS.L.00901

Parsons T, French J, Oshima T, Figueroa F, Neri T, Klasan A, et al. International survey of practice for prophylactic systemic antibiotic therapy in hip and knee arthroplasty. Antibiotics (Basel) 2022; 11: 1669. doi: 10.3390/antibiotics11111669. DOI: https://doi.org/10.3390/antibiotics11111669

Babu S, Al-Obaidi B, Jardine A, Jonas S, Al-Hadithy N, Satish V. A comparative study of 5 different antibiotic prophylaxis regimes in 4500 total knee replacements. J Clin Orthop Trauma 2020; 11: 108-12. doi: 10.1016/j.jcot.2018.12.003. DOI: https://doi.org/10.1016/j.jcot.2018.12.003

Berrios-Torres S I, Umscheid C A, Bratzler D W, Leas B, Stone E C, Kelz R R, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017; 152: 784-91. doi: 10.1001/jamasurg.2017.0904. DOI: https://doi.org/10.1001/jamasurg.2017.0904

Engesaeter L B, Lie S A, Espehaug B, Furnes O, Vollset S E, Havelin L I. Antibiotic prophylaxis in total hip arthroplasty: effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0–14 years in the Norwegian Arthroplasty Register. Acta Orthop Scand 2003; 74: 644-51. doi: 10.1080/00016470310018135. DOI: https://doi.org/10.1080/00016470310018135

Havelin L I, Fenstad A M, Salomonsson R, Mehnert F, Furnes O, Overgaard S, et al. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop 2009; 80: 393-401. doi: 10.3109/17453670903039544. DOI: https://doi.org/10.3109/17453670903039544

Sedrakyan A, Paxton E, Graves S, Love R, Marinac-Dabic D. National and international postmarket research and surveillance implementation: achievements of the International Consortium of Orthopaedic Registries initiative. J Bone Joint Surg Am 2014; 96: 1. doi: 10.2106/JBJS.N.00739. DOI: https://doi.org/10.2106/JBJS.N.00739

Downloads

Additional Files

Published

2023-08-09

How to Cite

Leta, T. H., Fenstad, A. M., Lygre, S. H. L., Lie, S. A., Lindberg-Larsen, M., Pedersen, A. B., … Furnes, O. (2023). The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania. Acta Orthopaedica, 94, 416–425. https://doi.org/10.2340/17453674.2023.17737

Issue

Vol. 94 (2023): Acta Orthopaedica

Section

Articles

Categories

License

Copyright (c) 2023 Tesfaye H Leta, Anne Marie Fenstad, Stein Håkon L Lygre, Stein Atle Lie, Martin Lindberg-Larsen, Alma B Pedersen, Annette W-Dahl, Ola Rolfson, Erik Bülow, James A Ashforth, Liza N van Steenbergen, Rob G H H Nelissen, Dylan Harries, Richard De Steiger, Olav Lutro, Emmi Hakulinen, Keijo Mäkelä, Jinny Willis, Michael Wyatt, Chris Frampton, Alexander Grimberg, Arnd Steinbrück, Yinan Wu, Cristiana Armaroli, Marco Molinari, Roberto Picus, Kyle Mullen, Richard Illgen, Ioan C Stoica, Andreea E Vorovenci, Dan Dragomirescu, Håvard Dale, Christian Brand, Bernhard Christen, Joanne Shapiro, J Mark Wilkinson, Richard Armstrong, Kate Wooster, Geir Hallan, Jan-Erik Gjertsen, Richard N Chang, Heather A Prentice, Elizabeth W Paxton, Ove Furnes

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Acta Orthopaedica (Scandinavica) content is available freely online as from volume 1, 1930. The journal owner owns the copyright for all material published until volume 80, 2009. As of June 2009, the journal has however been published fully Open Access, meaning the authors retain copyright to their work. As of June 2009, articles have been published under CC-BY-NC or CC-BY licenses, unless otherwise specified.
 
Crossref
Scopus
Google Scholar
Europe PMC