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Study: Antibiotic cement use for TKR does not impact 2-year revision rates
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Use of antibiotic-loaded bone cement during primary total knee replacement does not reduce the risk of early revision, according to recently presented findings by Canadian researchers.
“It appears the addition of antibiotics to cement for primary [total knee replacement] TKR in osteoarthritis has no clinically important effect on the risk of revision within 2 years of surgery,” study investigator Eric R. Bohm, MD, said. “Longer follow-up, as well as confirmation of these findings in other national registries, is warranted.”
Bohm presented the findings at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
A registry-based study of cemented total knee replacement revealed similar 2-year revision rates with or without antibiotic cement.
Image: Bohm ER
Cemented primary replacements
Bohm and colleagues used the Canadian Joint Replacement Registry to identify 36,681 patients with degenerative arthritis who had a cemented primary TKR and stratified the cohort to determine those revised within 2 years and the reasons for revision. The investigators noted whether antibiotics in the cement were used, as well as patients’ age, gender and comorbidities.
“We used a primary outcome metric of revision within 2 years for any reason because aseptic loosening and infection account for about 30% of early and 60% of late revisions in the Canadian Joint Replacement Registry,” Bohm said. “We also think it captures unanticipated negative consequences of using antibiotic-loaded bone cement. We felt that antimicrobial activity would be minimal by 2 years.”
Of the 36,681 patients, 16,665 patients had antibiotics added to their cement. Overall, there were 532 revisions (1.45%) during the 2-year period — 1.51% in the antibiotic cemented group and 1.4% in the non-antibiotic cemented group.
Cost-effectiveness
Bohm also looked at the cost-effectiveness of antibiotic cement. His group found that the revision rate of the antibiotic cemented group would need to reach 0.9% for the use of antibiotic bone cement to be cost-effective.
“The use of antibiotic-loaded bone cement does not change the 2-year revision risk,” Bohm said. “It does not appear to be cost-effective either.”
He noted that further revision data available for 206 of the 532 revision patients revealed that the non-antibiotic cemented group had twice as many aseptic loosening-related revisions as the antibiotic cemented group. However, they found no differences between the groups for rates of infection-related revision and pain of unknown origin. – by Robert Press
Reference:
- Bohm ER, Gu J, Zhu N, et al. The addition of antibiotics to cement does not appear to lower the risk of early revision in knee replacement surgery. Paper #133. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
- Eric R. Bohm, MD, can be reached at Concordia Joint Replacement Group, 310-1155 Concordia Ave., Winnipeg MB R2K 2M9, Canada; email: ebohm@cjrg.ca.
Disclosure:
- Bohm has performed paid presentations for DePuy. He also receives financial or material support from DePuy and Smith & Nephew.