Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement
Authors: Leta Tesfaye H. , Lie Stein Atle , Fenstad Anne Marie , Lygre Stein Håkon L. , Lindberg-Larsen Martin , Pedersen Alma B. , W-Dahl Annette , Rolfson Ola , Bülow Erik , van Steenbergen Liza N. , Nelissen Rob G. H. H. , Harries Dylan , de Steiger Richard , Lutro Olav , Mäkelä Keijo , Venäläinen Mikko S. , Willis Jinny , Wyatt Michael , Frampton Chris , Grimberg Alexander , Steinbrück Arnd , Wu Yinan , Armaroli Cristiana , Gentilini Maria Adalgisa , Picus Roberto , Bonetti Mirko , Dragosloveanu Serban , Vorovenci Andreea E. , Dragomirescu Dan , Dale Håvard , Brand Christian , Christen Bernhard , Shapiro Joanne , Wilkinson J. Mark , Armstrong Richard , Wooster Kate , Hallan Geir , Gjertsen Jan-Erik , Chang Richard N. , Prentice Heather A. , Sedrakyan Art , Paxton Elizabeth W. , Furnes Ove 
Published: May 2024

Importance

Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient.

Objective

To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement.

Design, Setting, and Participants

This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023.

Exposure

Primary TKA with ALBC vs plain bone cement.

Main Outcomes and Measures

The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 − Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes.

Results

Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement.

Conclusions and Relevance

In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.