Dual‐antibiotic bone cement (gentamicin + vancomycin) in preventing and treating infections during revision knee arthroplasty in high‐risk patients

TL;DR

This study shows that using bone cement with two antibiotics helps reduce infections in high-risk knee replacement surgeries.

Contribution

The study evaluates the effectiveness and safety of dual-antibiotic bone cement in high-risk revision knee arthroplasty patients.

Findings

DABC reduced postoperative infection rates in aseptic revisions to 5.3%.

Staphylococcus aureus and Staphylococcus epidermidis were the most common infection-causing organisms.

Kidney and wound complications occurred in 5.9% and 21.2% of patients, respectively.

Abstract

This study aimed to evaluate the treatment and preventive effects, as well as the safety, of dual‐antibiotic bone cement (DABC; gentamicin + vancomycin) in revision total knee arthroplasty (RTKA) in high‐risk patients.

This retrospective observational study included patients who underwent RTKA for septic or aseptic indications with intraoperative application of DABC (Copal G + V, Heraeus‐Medical GmbH) at our centre between December 2015 and December 2022. Patients were followed for a minimum of 2 years. Postoperative infection rates were documented, and preoperative patient risk was calculated using the periprosthetic joint infection (PJI) risk calculator. Microbiological profiles and antibiotic resistance patterns of postoperative infections were analysed, and all complications were recorded.

A total of 85 patients were included. The overall postoperative infection rate after DABC use was 17.6% (15/85), 95% confidence interval (CI) [11.0%, 27.1%], while the mean preoperative PJI risk percentage was 54.19 ± 16.58%. When stratified by revision indication, infection rates were 21.2% (14/66), 95% CI [13.1%, 32.5%] in septic revisions and 5.3% (1/19), 95% CI [0.9%, 24.6%] in aseptic revisions, with corresponding preoperative PJI risk values of 54.34 ± 16.95% and 53.65 ± 15.62%. Among the 15 patients who developed postoperative infections, the most common organisms were Staphylococcus aureus (n = 5) and Staphylococcus epidermidis (n = 5). Kidney complications occurred in 5.9% (5/85), 95% CI [0.8%, 11.0%], and wound complications in 21.2% (18/85), 95% CI [12.3%, 30.0%]. Implant removal or component exchange was required in 7.1% (6/85), 95% CI [1.5%, 12.6%].

DABC (G + V) demonstrated favourable infection control in septic RTKA and effective infection prevention in aseptic RTKA, with a low complication rate and good overall safety.

Level III.

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