Background: 

It is controversial whether the use of antibiotic-laden bone cement (ALBC) in primary total knee arthroplasty (TKA) affects periprosthetic joint infection (PJI) or revision rates. The impact of ALBC on outcomes of primary TKA have not been previously investigated in U.S. veterans, to our knowledge. The purposes of this study were to quantify utilization of ALBC among U.S. veterans undergoing primary TKA and to determine if ALBC usage is associated with differences in revision TKA rates.

Methods: 

Patients who had TKA with cement from 2007 to 2015 at U.S. Veterans Health Administration (VHA) hospitals with at least 2 years of follow-up were retrospectively identified. Patients who received high-viscosity Palacos bone cement with or without gentamicin were selected as the final study cohort. Patient demographic and comorbidity data were collected. Revision TKA was the primary outcome. All-cause revisions and revisions for PJI were identified from both VHA and non-VHA hospitals. Unadjusted and adjusted regression analyses were performed to identify variables that were associated with increased revision rates.

Results: 

The study included 15,972 patients who had primary TKA with Palacos bone cement at VHA hospitals from 2007 to 2015. Plain bone cement was used for 4,741 patients and ALBC was used for 11,231 patients. Utilization of ALBC increased from 50.6% in 2007 to 69.4% in 2015. At a mean follow-up of 5 years, TKAs with ALBC had a lower all-cause revision rate than those with plain bone cement (5.3% versus 6.7%; p = 0.0009) and a lower rate of revision for PJI (1.9% versus 2.6%; p = 0.005). On multivariable regression, ALBC use was associated with a lower risk of all-cause revision compared with plain bone cement (hazard ratio [HR]: 0.79, 95% confidence interval [CI]: 0.68 to 0.92; p = 0.0019). Seventy-one primary TKAs needed to be implanted with ALBC to avoid 1 revision TKA.

Conclusions: 

The utilization of ALBC for primary TKAs performed at VHA hospitals has increased over time and was associated with a lower all-cause revision rate and a lower rate of revision for PJI.

Level of Evidence: 

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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美国退伍军人初次全膝关节置换术后使用抗生素的骨水泥的使用和修订风险

背景： 

在原发性全膝关节置换术（TKA）中使用载有抗生素的骨水泥（ALBC）是否会影响假体周围关节感染（PJI）或翻修率存在争议。据我们所知，ALBC对原发性TKA结局的影响尚未在美国退伍军人中进行过调查。这项研究的目的是量化接受原发性TKA的美国退伍军人中ALBC的利用率，并确定ALBC的使用是否与修订TKA率的差异有关。

方法： 

回顾性分析了2007年至2015年在美国退伍军人健康管理局（VHA）医院接受过TKA水泥治疗并至少随访2年的患者。选择接受或不接受庆大霉素的高粘度Palacos骨水泥患者作为最终研究队列。收集患者的人口统计和合并症数据。修订TKA是主要结果。从VHA和非VHA医院中识别出PJI的所有原因修订和修订。进行未经调整和调整后的回归分析，以确定与修订率增加相关的变量。

结果： 

该研究纳入了2007年至2015年间VHA医院中有15,972例原发性TKA和Palacos骨水泥的患者。其中，纯骨水泥用于4,741例患者，ALBC用于11,231例患者。ALBC的使用率从2007年的50.6％增加到2015年的69.4％。平均随访5年，ALBC的TKA的全因翻修率低于普通骨水泥的TKA（5.3％对6.7％； p = 0.0009）和较低的PJI修订率（1.9％对2.6％； p = 0.005）。在多变量回归中，与普通骨水泥相比，ALBC的使用与全因翻修的风险较低（危险比[HR]：0.79，95％置信区间[CI]：0.68至0.92； p = 0.0019）。需要向ALBC植入71个主要TKA，以避免1次修订TKA。

结论： 

随着时间的流逝，ALBC在VHA医院进行的原发性TKA的使用有所增加，并且与全因修订率较低和PJI修订率较低相关。

证据级别： 

治疗级别III。有关证据水平的完整说明，请参见《作者说明》。