Observational Study

. 2023 Aug 9:94:416-425.

doi: 10.2340/17453674.2023.17737.

The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania

Tesfaye H Leta¹, Anne Marie Fenstad², Stein Håkon L Lygre³, Stein Atle Lie⁴, Martin Lindberg-Larsen⁵, Alma B Pedersen⁶, Annette W-Dahl⁷, Ola Rolfson⁸, Erik Bülow⁹, James A Ashforth¹⁰, Liza N Van Steenbergen¹¹, Rob G H H Nelissen¹², Dylan Harries¹³, Richard De Steiger¹⁴, Olav Lutro¹⁵, Emmi Hakulinen¹⁶, Keijo Mäkelä¹⁷, Jinny Willis¹⁸, Michael Wyatt¹⁸, Chris Frampton¹⁸, Alexander Grimberg¹⁹, Arnd Steinbrück¹⁹, Yinan Wu¹⁹, Cristiana Armaroli²⁰, Marco Molinari²¹, Roberto Picus²², Kyle Mullen²³, Richard Illgen²⁴, Ioan C Stoica²⁵, Andreea E Vorovenci²⁶, Dan Dragomirescu²⁶, Håvard Dale²⁷, Christian Brand²⁸, Bernhard Christen²⁹, Joanne Shapiro³⁰, J Mark Wilkinson³¹, Richard Armstrong³⁰, Kate Wooster³⁰, Geir Hallan²⁷, Jan-Erik Gjertsen²⁷, Richard N Chang³², Heather A Prentice³², Elizabeth W Paxton³², Ove Furnes²⁷

Affiliations

¹ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Faculty of Health Science, VID Specialized University, Norway; Department of Population Health Sciences, Weill Medical College of Cornell University, USA; Department of Medical Device Surveillance & Assessment, Kaiser Permanente, USA. tesfaye.hordofa.leta@helse-bergen.no.
² The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway.
³ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Occupational Medicine, Haukeland University Hospital, Norway.
⁴ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Institutes of Dentistry, University of Bergen, Norway.
⁵ The Danish Knee Arthroplasty Register, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark.
⁶ The Danish Knee Arthroplasty Register, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark.
⁷ The Swedish Arthroplasty Register, Sweden; Department of Clinical Sciences Lund, Division of Orthopedics, Lund University, Lund, Sweden.
⁸ The Swedish Arthroplasty Register, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁹ Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre of Registers Västra Götaland, Gothenburg, Sweden.
¹⁰ JointCare Registry, South Africa.
¹¹ The Dutch Arthroplasty Register, the Netherlands.
¹² The Dutch Arthroplasty Register, the Netherlands; Department of Orthopedics, Leiden University Medical Center, the Netherlands.
¹³ South Australian Health and Medical Research Institute, Australia.
¹⁴ The Australian Orthopaedic Association National Joint Replacement Registry, Australia.
¹⁵ Department of Medicine, Stavanger University Hospital, Norway.
¹⁶ The Finnish Institute for Health and Welfare, Finland.
¹⁷ The Finnish Arthroplasty Register, Finland; Turku University Hospital and University of Turku, Turku, Finland.
¹⁸ The New Zealand Joint Registry, New Zealand.
¹⁹ The Germany Arthroplasty Registry, Germany.
²⁰ Arthroplasty Registry of the Autonomous Province of Trento (PATN), Clinical Epidemiology Service, Provincial Agency for Health Services of Trento (APSS), Italy.
²¹ Orthopedics and Traumatology Operative Unit, Cavalese Hospital, Provincial Agency for Health Services of Trento (APSS), Italy.
²² Arthroplasty Register of Autonomous Province of Bolzano (PABZ), Observatory of Health, Health Department AP of Bolzano, Italy.
²³ American Joint Replacement Registry, USA.
²⁴ American Joint Replacement Registry, USA; University of Wisconsin-Madison School of Medicine and Public Health, Department of Orthopedic Surgery and Rehabilitation, USA.
²⁵ Romanian Arthroplasty Registry, Romania; University of Medicine and Pharmacy - Carol Davila - Bucharest - UMFCD Bucharest, Romania; Foisor Orthopedic Hospital, Romania.
²⁶ Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania.
²⁷ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
²⁸ Swiss National Hip & Knee Joint Registry, Switzerland; Institute of Social and Preventive Medicine, SwissRDL, University of Bern; Switzerland.
²⁹ Swiss National Hip & Knee Joint Registry, Switzerland; Articon, Bern, Switzerland.
³⁰ The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK.
³¹ The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
³² Medical Device Surveillance & Assessment, Kaiser Permanente, USA.

PMID: 37565339
PMCID: PMC10416222
DOI: 10.2340/17453674.2023.17737

Observational Study

The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania

Tesfaye H Leta et al. Acta Orthop. 2023.

. 2023 Aug 9:94:416-425.

doi: 10.2340/17453674.2023.17737.

Authors

Affiliations

¹ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Faculty of Health Science, VID Specialized University, Norway; Department of Population Health Sciences, Weill Medical College of Cornell University, USA; Department of Medical Device Surveillance & Assessment, Kaiser Permanente, USA. tesfaye.hordofa.leta@helse-bergen.no.
² The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway.
³ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Occupational Medicine, Haukeland University Hospital, Norway.
⁴ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Institutes of Dentistry, University of Bergen, Norway.
⁵ The Danish Knee Arthroplasty Register, Denmark; Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark.
⁶ The Danish Knee Arthroplasty Register, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Denmark.
⁷ The Swedish Arthroplasty Register, Sweden; Department of Clinical Sciences Lund, Division of Orthopedics, Lund University, Lund, Sweden.
⁸ The Swedish Arthroplasty Register, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁹ Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre of Registers Västra Götaland, Gothenburg, Sweden.
¹⁰ JointCare Registry, South Africa.
¹¹ The Dutch Arthroplasty Register, the Netherlands.
¹² The Dutch Arthroplasty Register, the Netherlands; Department of Orthopedics, Leiden University Medical Center, the Netherlands.
¹³ South Australian Health and Medical Research Institute, Australia.
¹⁴ The Australian Orthopaedic Association National Joint Replacement Registry, Australia.
¹⁵ Department of Medicine, Stavanger University Hospital, Norway.
¹⁶ The Finnish Institute for Health and Welfare, Finland.
¹⁷ The Finnish Arthroplasty Register, Finland; Turku University Hospital and University of Turku, Turku, Finland.
¹⁸ The New Zealand Joint Registry, New Zealand.
¹⁹ The Germany Arthroplasty Registry, Germany.
²⁰ Arthroplasty Registry of the Autonomous Province of Trento (PATN), Clinical Epidemiology Service, Provincial Agency for Health Services of Trento (APSS), Italy.
²¹ Orthopedics and Traumatology Operative Unit, Cavalese Hospital, Provincial Agency for Health Services of Trento (APSS), Italy.
²² Arthroplasty Register of Autonomous Province of Bolzano (PABZ), Observatory of Health, Health Department AP of Bolzano, Italy.
²³ American Joint Replacement Registry, USA.
²⁴ American Joint Replacement Registry, USA; University of Wisconsin-Madison School of Medicine and Public Health, Department of Orthopedic Surgery and Rehabilitation, USA.
²⁵ Romanian Arthroplasty Registry, Romania; University of Medicine and Pharmacy - Carol Davila - Bucharest - UMFCD Bucharest, Romania; Foisor Orthopedic Hospital, Romania.
²⁶ Romanian Arthroplasty Registry, Romania; Economic Cybernetics and Statistics Doctoral School, Bucharest University of Economic Studies, Romania.
²⁷ The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
²⁸ Swiss National Hip & Knee Joint Registry, Switzerland; Institute of Social and Preventive Medicine, SwissRDL, University of Bern; Switzerland.
²⁹ Swiss National Hip & Knee Joint Registry, Switzerland; Articon, Bern, Switzerland.
³⁰ The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; NEC Software Solutions, Hemel Hempstead, UK.
³¹ The National Joint Registry for England, Wales, Northern Ireland, The Isle of Man and Guernsey, UK; Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
³² Medical Device Surveillance & Assessment, Kaiser Permanente, USA.

PMID: 37565339
PMCID: PMC10416222
DOI: 10.2340/17453674.2023.17737

Abstract

Background and purpose: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA).

Patients and methods: This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries.

Results: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register).

Conclusion: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.

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Figures

**Figure 1**
Inclusion and exclusion criteria. ^a Excluded TKAs with insufficient data to determine whether inclusion criteria are met.

**Figure 2**
Trends in ALBC vs. plain bone cement used from 2010–2020. Left panel: pooled data from 14 of 16 participating registries with > 50% ALBC use in primary TKAs (2010–2020), see Table 3. Right panel: pooled data from 2 of 16 participating registries with < 50% ALBC use in primary TKAs (2010–2020)

**Figure 3**
Trends in ALBC usage in primary TKA among 8 of 16 registries that reported ≤ 90% usage of ALBC in primary TKA for at least 1 year in the period 2010–2020.

See this image and copyright information in PMC

References

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The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania

Affiliations

The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania

Authors

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous