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Published on: December 3, 2017
A Low Rate of Periprosthetic Infections after Aseptic Knee Prosthesis Revision Using Dual-Antibiotic-Impregnated Bone
Benedikt Paul Blersch1, Michael Barthels1, Philipp Schuster1,2
1Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
Aim:
The incidence of periprosthetic joint infections (PJI) following aseptic knee revision arthroplasty lies between 3% and 7.5%. The aim of this study was to verify the hypothesis that the use of dual-antibiotic-impregnated cement in knee revision arthroplasty leads to a lower rate of periprosthetic joint infections.
Methods:
We retrospectively reviewed 403 aseptic revision knee arthroplasties performed between January 2013 and March 2021 (148 revisions of a unicompartmental prosthesis, 188 revisions of a bicondylar total knee arthroplasty (TKA), 41 revisions of an axis-guided prosthesis, and 26 revisions of only one component of a surface replacement prosthesis). The bone cement Copal G+C (Heraeus Medical, Wertheim, Germany) with two antibiotics-gentamycin and clindamycin-was used for the fixation of the new implant. The follow-up period was 53.4 ± 27.9 (4.0-115.0) months.
Results:
Five patients suffered from PJI within follow-up (1.2%). The revision rate for any reason was 8.7%. Survival for any reason was significantly different between the types of revision (p = 0.026, Log-Rank-test), with lower survival rates after more complex surgical procedures. The 5-year survival rate with regard to revision for any reason was 91.3% [88.2-94.4%] and with regard to revision for PJI 98.2% [98.7-99.9%], respectively.
Conclusion:
The use of the dual-antibiotic-impregnated bone cement Copal G+C results in a lower rate of periprosthetic infections after aseptic knee prosthesis replacement than that reported in published prosthesis revisions using only one antibiotic in the bone cement.
Insights
Dual-antibiotic-impregnated cement significantly reduced periprosthetic joint infections (PJI) in knee revision arthroplasty. This study found a PJI rate of 1.2% using dual antibiotics, lower than historical rates with single antibiotics.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomaterials
Background:
- Periprosthetic joint infections (PJI) are a significant complication following knee revision arthroplasty, with reported incidence rates ranging from 3% to 7.5%.
- Optimizing infection prevention strategies is crucial for improving outcomes in revision knee surgery.
Purpose of the Study:
- To evaluate the efficacy of dual-antibiotic-impregnated bone cement in reducing PJI rates after aseptic knee revision arthroplasty.
- To test the hypothesis that using cement with gentamicin and clindamycin lowers PJI incidence compared to historical controls.
Main Methods:
- Retrospective review of 403 aseptic knee revision arthroplasties performed between January 2013 and March 2021.
- Utilized dual-antibiotic (gentamicin and clindamycin) impregnated bone cement (Copal G+C) for implant fixation.
- Follow-up duration averaged 53.4 months, assessing for periprosthetic joint infections and revision rates.
Main Results:
- A low incidence of PJI was observed, with only 5 patients (1.2%) developing infection within the follow-up period.
- The overall revision rate for any reason was 8.7%.
- The 5-year survival rate regarding revision for PJI was high at 98.2%.
Conclusions:
- The use of dual-antibiotic-impregnated bone cement (gentamicin and clindamycin) is associated with a reduced rate of PJI after knee revision arthroplasty.
- This approach appears more effective in preventing PJI compared to historical data using single-antibiotic bone cement.
