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Meta-Analysis
. 2019 Dec;98(49):e18068.
doi: 10.1097/MD.0000000000018068.

Antibiotic-impregnated bone cement for preventing infection in patients receiving primary total hip and knee arthroplasty: A meta-analysis

Jin Zhang  1   2 , Xiao-Yu Zhang  1 , Feng-Li Jiang  1 , Yi-Ping Wu  1 , Bei-Bei Yang  1 , Zi-Yun Liu  1 , Dong Liu  1   3
Affiliations
Meta-Analysis

Antibiotic-impregnated bone cement for preventing infection in patients receiving primary total hip and knee arthroplasty: A meta-analysis

Jin Zhang et al. Medicine (Baltimore). 2019 Dec.

Abstract

Background: Surgical-site infections after primary total joint arthroplasty (TJA) are a significant issue. Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected joints, but routine use of AIBC in primary TJA remains controversial. In this systematic review, we evaluated the efficacy of AIBC in reducing surgical-site infections after primary TJA.

Methods: We systematically searched Pubmed, EMbase, Cochrane Library, CMB, CNKI, and WanFang Data for studies (published until June 1, 2019) evaluating AIBC use in reducing infection rates. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Meta-analysis was performed using Review Manager 5.3 software. The registration number is CRD42017078341 in PROSPERO.

Results: In total, 10 studies were included, resulting in a sample size of 13,909 arthroplasty cases. The overall pooled data demonstrated that, compared with systemic antibiotics, AIBC was more effective in decreasing deep infection rates (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.14-0.89, P = .030), although there were higher superficial infection rates with AIBC (OR = 1.53, 95% CI = 1.11-2.11, P = .010). Compared to systemic antibiotics alone, AIBC with systemic antibiotics significantly decreased deep infection rates (OR = 0.55, 95% CI = 0.41-0.75, P = .0001) but there was no difference in superficial infection rates (OR = 1.43, 95% CI = 0.81-2.54, P = .220). In the subgroup analysis, both randomized controlled trials and cohort studies had reduced deep infection rates after primary TJA (OR = 0.61, 95% CI = 0.37-0.99, P = .050 and OR = 0.49, 95% CI = 0.34-0.70, P = .0001, respectively). AIBC decreased deep infection rates in both total hip and knee arthroplasty (OR = 0.25, 95% CI = 0.12-0.52, P = .0002 and OR = 0.62, 95% CI = 0.45-0.87, P = .005, respectively). Deep infection rates were significantly decreased by AIBC with gentamicin (OR = 0.31, 95% CI = 0.20-0.49, P < .00001) but unaffected by AIBC with cefuroxime (OR = 0.35, 95% CI = 0.10-1.20, P = .100). Deep infection rates in the AIBC and control groups were similar when laminar airflow was applied to the operating room (OR = 0.90, 95% CI = 0.60-1.35, P = .620); however, without laminar airflow, the efficacy of AIBC in decreasing deep infection rates was significantly higher than that of control group (OR = 0.21, 95% CI = 0.08-0.59, P = .003).

Conclusions: AIBC may significantly decrease deep infection rates after primary total hip and knee arthroplasty, with or without systemic antibiotics.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the literature searching.
Figure 2
Figure 2
The comparison in surgical site infection between AIBC and intravenous antibiotics after joint replacement. AIBC = antibiotic-impregnated bone cement.
Figure 3
Figure 3
The comparison in surgical site infection between AIBC combined intravenous antibiotics and intravenous antibiotics after joint replacement. AIBC = antibiotic-impregnated bone cement.
Figure 4
Figure 4
The comparison in deep surgical site infection with or without AIBC of different study designs. AIBC = antibiotic-impregnated bone cement.
Figure 5
Figure 5
The comparison in deep surgical site infection with or without AIBC of different surgical types. AIBC = antibiotic-impregnated bone cement.
Figure 6
Figure 6
The comparison in deep surgical site infection with or without AIBC of different antibiotics. AIBC = antibiotic-impregnated bone cement.
Figure 7
Figure 7
The comparison in deep surgical site infection with or without AIBC of different operating room conditions. AIBC = antibiotic-impregnated bone cement.
Figure 8
Figure 8
Funnel plot of studies in reducing deep surgical site infection rate with AIBC. AIBC = antibiotic-impregnated bone cement.
Figure 9
Figure 9
Egger test of studies in reducing deep surgical site infection rate with AIBC. AIBC = antibiotic-impregnated bone cement.
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