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Antibiotic-loaded bone cement is associated with a lower risk of revision following primary cemented total knee arthroplasty: an analysis of 731,214 cases using National Joint Registry data

Lookup NU author(s): Dr Theophile BigirumurameORCiD



This is the authors' accepted manuscript of an article that has been published in its final definitive form by British Editorial Society of Bone and Joint Surgery, 2019.

For re-use rights please refer to the publisher's terms and conditions.


AIMS: Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. MATERIALS AND METHODS: Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. RESULTS: Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. CONCLUSION: After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331-1347.

Publication metadata

Author(s): Jameson SS, Asaad A, Diament M, Kasim A, Bigirumurame T, Baker P, Mason J, Partington P, Reed M

Publication type: Article

Publication status: Published

Journal: The Bone & Joint Journal

Year: 2019

Volume: 101-B

Issue: 11

Pages: 1331-1347

Online publication date: 01/11/2019

Acceptance date: 02/04/2016

Date deposited: 20/01/2022

ISSN (print): 2049-4394

ISSN (electronic): 2049-4408

Publisher: British Editorial Society of Bone and Joint Surgery


DOI: 10.1302/0301-620X.101B11.BJJ-2019-0196.R1

PubMed id: 31674244


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