Study suggests protective effect of antibiotic-loaded cement against secondary revision in revised TKAs

DALLAS — Registry data presented here on aseptic revision total knee arthroplasties linked the use of antibiotic-loaded cement during the initial revision procedure with a 45% decrease in the risk of re-revision.

“In our dataset of 1,154 revision total knees, the overall re-revision rate at 2.2-year follow-up is approximately 10%. The mean time to re-revision was 4 years and the 5-year re-revision rate is going up toward 20% and increasing thereafter,” Stefano A. Bini, MD, said at the American Association of Hip and Knee Surgeons Annual Meeting. “When adjusting for the variables in our model, we did find that antibiotic cement decreased the risk of re-revision and surgeon experience may be associated with a high risk of revision, but we do believe that this is associated with patient selection.”

He added there was no association between outcomes and body mass index, gender and ASA scores.

Stefano A. Bini

In the retrospective cohort study, Bini and his colleagues identified 1,154 aseptic revision total knee arthroplasties. The patients had a mean age of 65 years and most were female. Antibiotic-loaded cement was used in 27% of cases.

The re-revision rate at 2.2 years was 9.9%, with an infection rate of 2.9%. The mean time to re-revision was 4 years. Infection was the most common reason for re-revision.

“When we looked at the multivariate analysis, what we found was the startling statistic that the use of antibiotic-loaded cement conferred a 45% decreased risk of revision if used at the time of the index revision procedure,” Bini said.

He added, “I want to be clear that the way we set up the model was looking for the risk of re-revision not the risk of infection, so the rate of infection when we are looking at the use of antibiotic-loaded cement did drop significantly almost by half, but the numbers of infected cases was too small to actually show any statistical significance.”

Increased surgeon experience also was associated with an increased risk of re-revision. Bini theorized this association may reflect more experienced surgeons taking on more complex cases.

He continued, “Basically, the use of antibiotic-loaded cement in this dataset showed that it is highly protective of re-revision, and this is in a multivariate analysis of a large dataset.” — by Gina Brockenbrough, MA

Reference:

Bini SA. Paper #12. Presented at: the American Association of Hip and Knee Surgeons Annual Meeting; Nov. 7-9, 2014; Dallas.

Disclosure: Bini has no relevant financial disclosures.