Abstract:
Background:Prosthetic joint infection (PJI) is the most serious total joint arthroplasty (TJA) complication despite several aseptic and antiseptic preventive measures. There is no clear evidence or even consensus, whether antibiotic-loaded bone cement (ALBC) should be used, in addition to systemic short-term routine antibiotic prophylaxis, to reduce the risk of PJI in primary TJA. We aimed to analyze the efficacy of ALBC for prevention of PJI in patients undergoing primary TJA. Methods:We searched systematically for randomized controlled trials (RCTs) in PubMed, Scopus, Embase, Web of Science and Cochrane library. Two reviewers independently screened potentially eligible studies according to predefined selection criteria and assessed the risk of bias using a modified version of the Cochrane risk of bias tool. PJI was prespecified as the primary outcome of interest. The meta-analyses were based on risk ratios using random-effects model per default. For the purpose of sensitivity, the corresponding fixed effects model odds ratios were calculated with the use of the Peto method as well. To evaluate a potential difference in effect sizes using different types (subgroups) of antibiotics used in bone cement, and at different follow-up periods, we performed stratified meta-analyses. Results:Thirty-seven studies were eligible for the systematic review and qualitative synthesis, and 9 trials (6507 total joint arthroplasties) were included in this meta-analysis. Overall ALBC significantly reduced the risk of PJI following primary TJAs (RRs, 0.36; 95% CIs, 0.16 to 0.80; P = 0.01) with a moderate degree of inconsistency (I2 = 47%). Based on stratified meta-analyses the use of gentamicin appeared to have a better effect (P = 0.0005) in the total hip arthroplasty. Pooled data of different antibiotics used in knee arthroplasties showed a significant association of cefuroxime (RRs, 0.08; 95% CIs, 0.01 to 0.63; P = 0.02). Further, ALBCs significantly reduced the PJI at one and two years of follow-up (P = 0.03 and P = 0.005 respectively). Conclusions:The evidence suggests that ALBCs are effective in reducing the PJI following primary TJA; i.e. between 20 and 84% reduced risk. However, the clear limitations of the available trial evidence highlight the need for joint-specific confirmatory trials, that will need to be designed as cluster-randomized trials of clinics in countries with well-functioning arthroplasty registries.The translational potential of this article: This meta-analysis highlights the prophylactic potential of ALBCs in lowering the risk of infection following primary hip or knee arthroplasties but emphasizes the need for more recent confirmatory trials.
journal_name
J Orthop Translatjournal_title
Journal of orthopaedic translationauthors
Sebastian S,Liu Y,Christensen R,Raina DB,Tägil M,Lidgren Ldoi
10.1016/j.jot.2020.04.005subject
Has Abstractpub_date
2020-05-08 00:00:00pages
53-60eissn
2214-031Xissn
2214-0328pii
S2214-031X(20)30050-4journal_volume
23pub_type
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
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更新日期:2015-06-23 00:00:00
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
doi:10.1016/j.jot.2016.11.002
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2020.06.002
更新日期:2020-07-22 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2019.02.003
更新日期:2019-03-07 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
doi:10.1016/j.jot.2017.02.006
更新日期:2017-03-31 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2017.12.004
更新日期:2018-01-02 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2020.10.004
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
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journal_title:Journal of orthopaedic translation
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journal_title:Journal of orthopaedic translation
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doi:10.1016/j.jot.2019.06.003
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
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更新日期:2019-12-05 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
doi:10.1016/j.jot.2018.03.003
更新日期:2018-04-14 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章,评审
doi:10.1016/j.jot.2018.02.001
更新日期:2018-03-07 00:00:00
abstract::[This corrects the article DOI: 10.1016/j.jot.2017.02.001.]. ...
journal_title:Journal of orthopaedic translation
pub_type: 已发布勘误
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更新日期:2018-02-03 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2019.10.004
更新日期:2019-11-04 00:00:00
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journal_title:Journal of orthopaedic translation
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更新日期:2015-08-28 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2015.08.003
更新日期:2015-08-20 00:00:00
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journal_title:Journal of orthopaedic translation
pub_type: 杂志文章
doi:10.1016/j.jot.2018.08.003
更新日期:2018-09-09 00:00:00