Is the use of antibiotic loaded cement compared to top plain cement associated with lower rate of revision?

Background

Antibiotic loaded bone cement (ALBC) is commonly used in cemented total hip arthroplasty (THA) in an attempt to reduce the risk of prosthetic joint infection (PJI). However, its role versus plain cement remains controversial due to the potential risk of developing resistant organisms and potential excess costs incurred from its usage. We investigated the relationship of ALBC and plain cement in affecting outcome of revision surgery after primary THA.

Methods

We conducted a retrospective study of data collected from National Joint Registry for England and Wales, Northern Ireland and the Isle of Man between 1st September 2005 until 31st August 2017. A logistic regression analysis model was used to investigate the association between ALBC versus plain cement and the odds ratio(OR) for revision, adjusting for age, ASA grade, bearing surfaces, head size and cup and stem fixation. Indications for revision recorded in NJR were considered in separate models.

Results

We identified 418,925 THAs where bone cements were used (22,037 plain cement; 396,888 ALBC). After adjusting for confounding factors, the risk of revision for infection was lower with ALBC (OR 0.77, 95% CI 0.62-0.95). There were also lower risk of revision for aseptic loosening of stem (OR 0.53, 95% CI 0.39-0.72), aseptic loosening of socket (OR 0.46, 95% CI 0.37- 0.58). When breaking down hips into fully cemented or hybrid fixation, the protective effect of ALBC against infection was only apparent in fully cemented (OR 0.65, 95% CI 0.48-0.87) when compared against hybrid fixation (OR 0.90, 95% CI 0.66-1.23).

Conclusion

Within the limits of registry analysis, this study has demonstrated an association between the use of ALBC and lower rates of revision for infection and aseptic loosening. This finding supports the current use of ABLC in cemented THAs.

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