MedicalResearch.com Interview with:
Darwin Chen, MD
Assistant Professor of Orthopedic Surgery
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Periprosthetic joint infection unfortunately remains a leading cause of total knee arthroplasty failure. One method of mitigating the risk of PJI is to use antibiotic loaded bone cement in a prophylactic fashion.
While the use of antibiotic cement makes inherent sense, the decision is not as simple as it seems. There are potential side effects such as renal damage, antibiotic hypersensitivity, and antibiotic resistance. Antibiotics decrease the mechanical strength of cement fixation, which may impact component loosening. Additionally, antibiotic cement is significantly more expensive than standard cement, driving up cost. Currently there is no consensus on if antibiotic cement truly reduces infection risk and there are many conflicting studies.
The purpose of our study is the use a large national database to evaluate real world utilization patterns of antibiotic cement, and assess outcomes, complications, and cost associated with antibiotic cement usage. Our hypothesis was that antibiotic cement is associated with a decreased risk of infection and no increased risk of systemic complications.
MedicalResearch.com: What should readers take away from your report?
Response: We found that there are decreased odds of postoperative infection when antibiotic cement is used routinely in primary total knee replacement, however this is offset by increased odds of acute kidney injury.
With regards to antibiotic cement usage trends nationally, overall utilization is approximately 27%. There was higher usage in medium/large size and urban hospitals. There was also non-selective usage, meaning surgeons are choosing to routinely use or not use antibiotic cement, not based on risk.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our recommendation is for use of antibiotic cement in high risk cases, however to also consider usage in routine primary cases as long as there is no preexisting renal disease.
Citation: AAOS 2019 abstract
Poster Presentation: Antibiotic-Loaded Bone Cement in Primary Total Knee Arthroplasty: Utilization Patterns and Impact on Complications Using a National Database
Date: Tuesday, March 12th
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