Total knee arthroplasty revision risks depending on the bone cement used—Data from 50,545 knee replacements of the Catalan Arthroplasty Registry

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-05-26 DOI:10.1002/jeo2.70271

Daniel Perez-Prieto, Katharina Koetter, Albert Fontanellas-Fes, Olga Martínez-Cruz, the RACat working group

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引用次数: 0

Abstract

Purpose

Clinical data on individual bone cement brands and viscosities in cemented total knee arthroplasty (TKA) is scarce. The Catalan arthroplasty registry (RACat) documents usage of cement brands including viscosities and the inclusion of antibiotics. The objective was to compare the clinical performance of the widely used bone cement brand PALACOS® to other blinded bone cement brands in TKA using data from the RACat.

Methods

Patient data on 50,545 primary TKA between 2007 and 2017 in the RACat were analysed retrospectively. Implant survival of PALACOS bone cement was compared to other blinded bone cement brand groups using the all-cause revision risk as primary study endpoint.

Results

Comparing implant survival, it was found that (1) PALACOS® (with or without gentamicin) was associated with a significantly lower revision risk compared to other cement brands (with or without antibiotics) (p = 0.001): RR PALACOS 2.03% versus RR other brands 3.88%, and RR PALACOS+G 1.84% versus RR other antibiotic-loaded bone cements (ALBC) 3.85%; (2) ALBC (all brands) did not reduce the risk of revisions (p = n.s) compared to plain bone cements (PBC); and (3) the medium viscosity PALACOS MV+G showed the lowest reoperation risk versus other ALBC (all viscosities): RR 1.12% versus RR 3.85%. Competing-risk regression models confirmed reduction in revision risk for all PALACOS compared with other brands (p = 0.001) and for PALACOS+G compared with other ALBC (p < 0.001) but showed no difference when comparing all ALBC with all PBC (p = 0.403). Comparing PALACOS MV+G with all other ALBC showed reduction of revision risk (p < 0.001) and no difference when comparing PALACOS medium viscosity (MV) with all other PBC (p = 0.108).

Conclusions

Type of cement brand, viscosity and the addition of antibiotics have an impact on revision risk of TKA. Medium viscosity cement with gentamicin (PALACOS MV+G), for which no clinical data were previously available, was associated with the lowest revision risk in TKA.

Level of Evidence

Level III, retrospective comparative study.

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全膝关节置换术翻修风险取决于所使用的骨水泥——来自加泰罗尼亚关节置换术注册中心50545例膝关节置换术的数据

目的骨水泥全膝关节置换术中单个骨水泥牌号和黏度的临床资料较少。加泰罗尼亚关节置换术注册（RACat）记录了水泥牌号的使用情况，包括粘度和抗生素的使用情况。目的是比较广泛使用的骨水泥品牌PALACOS®与其他盲法骨水泥品牌在TKA中的临床表现，使用来自RACat的数据。方法回顾性分析2007 - 2017年RACat地区50545例原发性TKA患者资料。以全因翻修风险作为主要研究终点，将PALACOS骨水泥与其他盲法骨水泥品牌组的种植体存活率进行比较。结果比较种植体存活，发现(1)PALACOS®（含或不含庆大霉素）与其他水泥品牌（含或不含抗生素）相比，翻修风险显著降低（p = 0.001）： PALACOS的RR为2.03%，其他品牌的RR为3.88%，PALACOS+G的RR为1.84%，其他含抗生素骨水泥（ALBC）的RR为3.85%；(2)与普通骨水泥（PBC）相比，ALBC（所有品牌）没有降低翻修风险（p = ns）；(3)中等粘度PALACOS MV+G与其他ALBC（所有粘度）相比，再手术风险最低：RR为1.12%，RR为3.85%。竞争风险回归模型证实，与其他品牌相比，所有PALACOS的修订风险降低（p = 0.001）， PALACOS+G与其他ALBC相比（p < 0.001），但在将所有ALBC与所有PBC进行比较时，没有显示差异（p = 0.403）。PALACOS MV+G与所有其他ALBC比较显示翻修风险降低（p < 0.001）， PALACOS介质粘度（MV）与所有其他PBC比较无差异（p = 0.108）。结论水泥牌号类型、黏度、抗生素添加量对TKA翻修风险有影响。中粘度水泥与庆大霉素（PALACOS MV+G），先前没有临床数据，与TKA翻修风险最低相关。证据等级III级，回顾性比较研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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