The economics of using prophylactic antibiotic-loaded bone cement in total knee replacement
- C. J. Gutowski, MD, MPH, Orthopaedic Surgery Resident1 ;
- B. M. Zmistowski, BA, Medical Student2;
- C. T. Clyde, BA, Medical Student2; and
- J. Parvizi, MD, PhD, Professor of Orthopaedic Surgery3
1Thomas Jefferson University, Department of Orthopaedic Surgery, 1025 Walnut St, 516 College Building, Philadelphia, Pennsylvania 19107, USA.
2Thomas Jefferson University, 1025 Walnut St, 516 College Building, Philadelphia, Pennsylvania 19107, USA.
3Rothman Institute at Thomas Jefferson University, Sheridan Building 10th Floor, 125 South 9th St., Philadelphia, Pennsylvania 19017, USA.
- Correspondence should be sent to Dr C. J. Gutowski; e-mail:gutowski1@gmail.com
Abstract
La tasa de infección periprotésica tras el reemplazo total de la articulación sigue aumentando, y los intentos de frenar esta tendencia han incluido el uso de cemento óseo impregnado de antibiótico en el momento de la cirugía primaria . Hemos investigado la clínica y el coste -efectividad del uso de cemento impregnado de antibiótico para el reemplazo total de rodilla primaria ( TKR ) mediante la comparación de la tasa de infección en 3048 TKRs realizado sin cemento cargado en un período de tres años frente a la incidencia de la infección después de 4830 TKRs realizados con cemento tobramicina cargado durante un período de tiempo posterior de una duración similar. Con el fin de ajustar por factores de confusión , la tasa de infección en 3347 y 4702 artroplastias totales de cadera no cementadas ( THR) realizadas durante los mismos períodos , respectivamente, también se examinó . No hubo diferencias significativas en las características de los pacientes en los diferentes cohortes .
La tasa absoluta de la infección aumentó cuando se utilizó cemento impregnado de antibiótico en TKR . Sin embargo , esta tasa de crecimiento fue inferior a la tasa de aumento de la infección después de cementado THR durante el mismo período. Si el aumento de la tasa de infección observada en THR se extrapolaron a la cohorte TKR , se habría esperado 18 casos adicionales de infección que se produzca en la cohorte que recibió de cemento impregnado de antibiótico , en comparación con el número observado . Dependiendo del tipo de cemento impregnado de antibiótico que se utiliza , su costo en todas las PTR primaria oscila entre USD $ 2,112.72 y USD $ 112 606,67 por caso de infección que se evitó .
The rate of peri-prosthetic infection following total joint replacement continues to rise, and attempts to curb this trend have included the use of antibiotic-loaded bone cement at the time of primary surgery. We have investigated the clinical- and cost-effectiveness of the use of antibiotic-loaded cement for primary total knee replacement (TKR) by comparing the rate of infection in 3048 TKRs performed without loaded cement over a three-year period versus the incidence of infection after 4830 TKRs performed with tobramycin-loaded cement over a later period of time of a similar duration. In order to adjust for confounding factors, the rate of infection in 3347 and 4702 uncemented total hip replacements (THR) performed during the same time periods, respectively, was also examined. There were no significant differences in the characteristics of the patients in the different cohorts.
The absolute rate of infection increased when antibiotic-loaded cement was used in TKR. However, this rate of increase was less than the rate of increase in infection following uncemented THR during the same period. If the rise in the rate of infection observed in THR were extrapolated to the TKR cohort, 18 additional cases of infection would have been expected to occur in the cohort receiving antibiotic-loaded cement, compared with the number observed. Depending on the type of antibiotic-loaded cement that is used, its cost in all primary TKRs ranges between USD $2112.72 and USD $112 606.67 per case of infection that is prevented.
Cite this article: Bone Joint J 2014;96-B:65–9.
Footnotes
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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
This article was primary edited by D. Rowley and first-proof edited by J. Scott.
- Received December 7, 2012.
- Accepted August 28, 2013.
- ©2014 The British Editorial Society of Bone & Joint Surgery