Is the use of antibiotic-loaded bone cement associated with a lower risk of revision after primary total hip arthroplasty?

Aims The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. Methods The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis. Results The cohort included 418,857 THAs of whom 397,896 had received antibiotic-loaded bone cement and 20,961 plain cement. After adjusting for putative confounding factors, the risk of revision for PJI was lower in those in whom antibiotic-loaded bone cement was used (hazard ration (HR) 0.79; 95% confidence interval (CI) 0.64 to 0.98). There was also a protective effect on the risk of revision due to aseptic loosening or osteolysis, in the period of > 4.1 years after primary THA, HR 0.57, 95% CI 0.45, 0.72. Conclusion Within the limits of registry analysis, this study showed an association between the use of antibiotic-loaded bone cement and lower rates of revision due to PJI. The findings support the continued use of antibiotic-loaded bone cement in cemented THA. Cite this article: Bone Joint J 2020;102-B(8):997–1002.

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Effect of dislocation timing following primary total hip arthroplasty on the risk of redislocation and revision

Hip International ◽

10.1177/1120700019828144 ◽

2019 ◽

Vol 29 (5) ◽

pp. 489-495 ◽

Cited By ~ 1

Author(s):

German A Norambuena ◽

Cody C Wyles ◽

Robert E Van Demark ◽

Robert T Trousdale

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Proportional Hazards ◽

Time Lapse ◽

Cox Proportional Hazards ◽

First Episode ◽

Developmental Hip Dysplasia ◽

Total Hip ◽

Primary Total Hip Arthroplasty

Introduction:There is little data regarding timing of index dislocation in patients who undergo primary total hip arthroplasty (THA) and subsequent risk of redislocation and revision.Methods:Between 1992 and 2013, 21,490 primary THAs were performed at a single institution. 189 patients (190 hips) had a first episode of dislocation within one year of index surgery (0.9 %). 32 patients (32 hips) were excluded for the following reasons: complex THA secondary to fracture malunion, Crowe III/IV developmental hip dysplasia, periprosthetic fracture, prior hip surgery, incomplete information, and hip abductor avulsion. The final cohort consisted of 157 patients (158 hips) who experienced dislocation within 1 year of primary non-complex THA. 88 patients were female (56%), mean age was 61 years (SD = 14), and mean follow-up was 76 months (range 0–229). Multivariable Cox proportional-hazards regression models with fractional polynomial models were used to estimate the association between timing of index dislocation and subsequent redislocation and revision surgery.Results:69 patients (44%) redislocated at final follow-up. Revision for any cause occurred in 26 out of 157 hips (17%). Time lapse from index THA to first dislocation was significantly associated with the risk of redislocation ( p = 0.004) and with the risk of revision ( p = 0.04). For every additional 7 days from surgery, risk of redislocation increased by a factor of 1.1 and risk of revision was increased by a factor of 1.13.Conclusion:This study demonstrates there is a lower risk of redislocation and revision in patients who have a first episode of dislocation closer to primary THA.

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No Association of CALCA Polymorphisms and Aseptic Loosening after Primary Total Hip Arthroplasty

BioMed Research International ◽

10.1155/2018/3687415 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Tünay Aydin-Yüce ◽

Gina Kurscheid ◽

Hagen Sjard Bachmann ◽

Thorsten Gehrke ◽

Marcel Dudda ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Aseptic Loosening ◽

Hip Arthroplasty ◽

Fragment Length Polymorphism ◽

Genotype Distribution ◽

Chain Reaction ◽

Total Hip ◽

Polymerase Chain ◽

European Group ◽

Primary Total Hip Arthroplasty

Studies of aseptic loosening showed an influence of calcitonin andα-CGRP, both encoded from the calcitonin/α-CGRP (CALCA) gene by alternative splicing. The aim of this study was to detect a possible association of the CALCA polymorphisms P1(rs1553005), P2(rs35815751), P3(rs5240), and P4(rs2956) with the time to aseptic loosening after THA. 320 patients suffering from aseptic loosening after primary total hip arthroplasty were genotyped for CALCA-P1 polymorphism and 161 patients for CALCA-P2 and CALCA-P3 polymorphisms and 160 patients for CALCA-P4 polymorphism. CALCA genotypes were determined by polymerase chain reaction and restriction-fragment length polymorphism. The genotype distribution of CALCA-P1 was CC 10%, CT 43%, and 46% TT. CALCA-P2 showed a distribution of 90.7%II, 8.7% ID, and 0.6% DD. The CALCA-P3 genotype distribution was 97.5% TT and 2.5% TC. The CALCA-P4 genotype distribution was 48.1% AA, 40% AT, and 11.9% TT. Significant differences between the CALCA genotypes were not found concerning age at implantation and replantation, BMI, gender, and cementation technique. No associations of the time for aseptic loosening were found. In conclusion, we did not find a significant association of CALCA polymorphisms and the time to aseptic loosening after primary THA in a Western European group.

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DOES TOPICAL USE OF GENTAMICIN REDUCE THE INFECTION RATE IN PRIMARY TOTAL HIP ARTHROPLASTY?

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192704219177 ◽

2019 ◽

Vol 27 (4) ◽

pp. 197-201 ◽

Cited By ~ 1

Author(s):

Caio Luiz de Toledo Oliveira ◽

Felipe Abrahão Elias ◽

André dos Santos Ribacionka ◽

Celso Hermínio Ferraz Picado ◽

Flávio Luís Garcia

Keyword(s):

Total Hip Arthroplasty ◽

Antibiotic Prophylaxis ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

University Hospital ◽

Fisher Exact Test ◽

Infection Rates ◽

Total Hip ◽

Primary Total Hip Arthroplasty

ABSTRACT Objective: To determine whether the topical use of gentamicin reduces periprosthetic joint infection rates in primary total hip arthroplasty (THA). Methods: We retrospectively evaluated two cohorts of patients who underwent primary THA in a university hospital, with a minimum of 1-year postoperative follow-up and full clinical, laboratory, and radiological documentation. Patients who underwent operation in the first 59 months of the study period (263 hips) received only intravenous cefazolin as antibiotic prophylaxis (Cef group), and those who underwent operation in the following 43 months (170 hips) received intravenous cefazolin plus topical gentamicin directly applied on the wound as antibiotic prophylaxis (Cef + Gen group). For the diagnosis of periprosthetic joint infection, we used the criteria of the Centers for Disease Control and Prevention. Data were analyzed using the Fisher exact test, and p values of <0.05 were considered significant. Results: Thirteen hips (4.9%) in the Cef group and eight hips (4.7%) in the Cef + Gen group presented periprosthetic joint infection. Statistical analysis revealed no difference between the infection rates (p = 1.0). Conclusion: Topical gentamicin as used in this study did not reduce periprosthetic joint infection rates in primary THA. Level of Evidence III, Retrospective comparative study.

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