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Revision for deep infection following THA unaffected by antibiotic cement
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GLASGOW — Based on their analysis of registry data, orthopedic investigators from New Zealand have found that using prophylactic antibiotic-laden cement did not affect revision rates due to deep infection following total hip arthroplasty.
Angus Wickham and colleagues assessed data from the New Zealand National Joint Registry to quantify the use of prophylactic antibiotic bone cement in the country and to determine its effectiveness. Data from 32,646 hip replacements performed between 1999 and 2007 were analyzed. Of those, 177 were revised for infection and 413 for loosening, Wickham reported.
“This shows the increasing use of antibiotic bone cement for prophylaxis over that time period, so that now [more than] two-thirds of hip joint replacements in New Zealand have prophylactic antibiotic bone cement,” Wickham said at the 2010 Meeting of the Combined Orthopaedic Associations.
Repeated analysis
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The investigators performed a Cox regression analysis, controlling for such confounding factors as age, sex, use of surgical suits, and length of surgery.
“We found that there is no significant difference in the rate of revision for deep infection or aseptic loosening with the use of antibiotic bone cement,” Wickham said. “This is not what I expected from the study initially. [We have] subsequently gone back and looked at the first 10 years of data from the joint registry, used a different statistician and again found that there is no significant difference.”
Benefits, disadvantages
A potential benefit of using prophylactic antibiotic bone cement includes a high local concentration of antibiotics around the prosthesis during the high-risk perioperative period, although this has been a subject of controversy in the literature, Wickham stated. Consistent benefits have been shown, however, when using prophylactic antibiotic bone cement in revision total hip replacements.
Wickham said potential disadvantages of prophylactic antibiotic bone cement include: weakened structural integrity, systemic toxicity, allergic reactions, drug-resistant bacteria, false negative cultures and cost.
“The New Zealand Joint Registry does not indicate there is any significant advantage of using [prophylactic antibiotic bone cement] routinely, and there are potential disadvantages that should be considered,” Wickham said. “I’m suggesting an individualized approach to using prophylactic antibiotic bone cement. High-risk patients, such as those who have rheumatoid arthritis or have had a previous infection in their joint, should receive antibiotic bone cement, whereas routine primary hip replacement patients should receive plain cement.” – by Thomas M. Springer
Reference:
- Wickham A, Atkinson D, Walker C. Antibiotic bone cement use in primary total hip joint replacements in New Zealand. Presented at the 2010 Meeting of the Combined Orthopaedic Associations. Sept. 12-17. Glasgow.
- Angus Wickham can be reached at angus.wickham@gmail.com.
