无论骨水泥中是否使用抗生素，初次全膝关节置换术中全身预防性抗生素的剂量均可减少：一项基于多注册研究的荟萃分析。
Number of Doses of Systemic Antibiotic Prophylaxis May Be Reduced in Cemented Primary Knee Arthroplasty Irrespective of Use of Antibiotic in the Cement: A Multiregistry-Based Meta-Analysis.
作者信息
Leta Tesfaye H, Chang Richard N, Fenstad Anne Marie, Lie Stein Atle, Lygre Stein Håkon L, Lindberg-Larsen Martin, Pedersen Alma B, Lutro Olav, Willis Jinny, Frampton Chris, Wyatt Michael, Dragosloveanu Serban, Vorovenci Andreea E, Dragomirescu Dan, Dale Håvard, Hallan Geir, Gjertsen Jan-Erik, Prentice Heather A, Furnes Ove, Sedrakyan Art, Paxton Elizabeth W
机构信息
The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.
Faculty of Health Science, VID Specialized University, Bergen, Norway.
出版信息
JB JS Open Access. 2024 Dec 11;9(4). doi: 10.2106/JBJS.OA.24.00140. eCollection 2024 Oct-Dec.
BACKGROUND
The use of systemic antibiotic prophylaxis (SAP) and antibiotic-loaded bone cement (ALBC) is the accepted practice to reduce the risk of periprosthetic joint infection (PJI) in primary total knee arthroplasty (pTKA). However, practice varies internationally. This study's primary aim was to compare the risk of PJI revision after pTKA with ALBC + SAP vs. plain bone cement (PBC) + SAP, and the secondary aim was to assess whether the risk of PJI revision varies with the number of SAP doses.
METHODS
Cohort of 289,926 pTKAs for osteoarthritis from arthroplasty registries in Denmark, New Zealand, Norway, Romania, and United States registered from 2010 to 2020. One-year revision for PJI following pTKA with ALBC + SAP vs. PBC + SAP, and single vs. multiple SAP doses was compared. We computed cumulative percent revision (1 minus Kaplan-Meier) using distributed analysis method and adjusted hazard rate ratios (HRRs) using Cox regression analyses within each registry. Advanced distributed meta-analysis was performed to summarize HRRs from all countries.
RESULTS
Among all pTKAs, 64.4% were performed with ALBC + SAP. Each registry reported a 1-year cumulative percent revision for PJI of <1.00% for both pTKAs with ALBC + SAP (0.34%-0.80%) and with PBC + SAP (0.54%-0.69%). The distributed meta-analysis showed HRR = 1.21; (95% confidence interval [CI], 0.79-1.87) for ALBC + SAP compared with PBC + SAP. Similar risk of PJI revision was observed between pTKAs with ALBC + single vs. multiple doses of SAP: 2 doses (0.95; 95% CI, 0.68-1.33), 3 doses (1.09; 95% CI, 0.64-1.87), and 4 doses (1.23; 95% CI, 0.69-2.21). Comparable results were found for the PBC + SAP group except for higher risk of PJI revision with 4 doses of SAP (2.74; 95% CI, 1.11-6.75).
CONCLUSIONS
ALBC and PBC entailed similar risk of PJI revision when patients received SAP in pTKA, regardless of number of SAP doses. ALBC or PBC used in combination with SAP in pTKAs, with one single preoperative dose of SAP may be sufficient without compromising the patient safety.
LEVEL OF EVIDENCE
Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
使用全身性抗生素预防（SAP）和载抗生素骨水泥（ALBC）是在初次全膝关节置换术（pTKA）中降低假体周围关节感染（PJI）风险的公认做法。然而，国际上的做法各不相同。本研究的主要目的是比较pTKA术后使用ALBC + SAP与普通骨水泥（PBC）+ SAP后PJI翻修的风险，次要目的是评估PJI翻修风险是否随SAP剂量的数量而变化。
方法
对丹麦、新西兰、挪威、罗马尼亚和美国2010年至2020年关节置换登记处登记的289,926例因骨关节炎进行pTKA的病例进行队列研究。比较pTKA术后使用ALBC + SAP与PBC + SAP以及单次与多次SAP剂量后1年PJI翻修情况。我们使用分布式分析方法计算累积翻修百分比（1减去Kaplan-Meier法），并在每个登记处使用Cox回归分析调整风险比（HRR）。进行高级分布式荟萃分析以总结所有国家的HRR。
结果
在所有pTKA中，64.4%采用ALBC + SAP进行。每个登记处报告，pTKA术后使用ALBC + SAP（0.34%-0.80%）和PBC + SAP（0.54%-0.69%）的PJI 1年累积翻修百分比均<1.00%。分布式荟萃分析显示，与PBC + SAP相比，ALBC + SAP的HRR = 1.21；（95%置信区间[CI]，0.79-1.87）。在使用ALBC +单次与多次剂量SAP的pTKA之间观察到相似的PJI翻修风险：2剂（0.95；95%CI，0.68-1.33）、3剂（1.09；95%CI，0.64-1.87）和4剂（1.23；95%CI，0.69-2.21）。PBC + SAP组也有类似结果，但4剂SAP时PJI翻修风险更高（2.74；95%CI，1.11-6.75）。
结论
在pTKA中患者接受SAP时，ALBC和PBC导致的PJI翻修风险相似，与SAP剂量数量无关。在pTKA中，ALBC或PBC与SAP联合使用，术前单次剂量的SAP可能就足够了，且不影响患者安全。
证据水平
III级。有关证据水平的完整描述，请参阅作者指南。
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