Yangbin Cao, Peiyuan Tang, Hua Chai, Wenbo Ma, Bin Lin, Ying Zhu, Ahmed Abdirahman, Wenfeng Xiao, Jun Zhang, Yusheng Li, Shuguang Liu, Ting Wen
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The clinical outcomes were evaluated for effectiveness by several indicators, including surface infection rate (SIR), deep infection rate (DIR), total infection rate (TIR), unadjusted/adjusted all-cause revision rate, and revision rate for PJI.</p><p><strong>Results: </strong>We synthesized the results of ten meta-analyses. Two meta-analyses had high AMSTAR 2 scores, two had moderate AMSTAR 2 ratings, three had critically low AMSTAR 2 scores, and the remaining meta-analyses had low AMSTAR 2 ratings. In terms of postoperative surgical site infection and revision rate, SIR (OR 1.50, 95% CI 1.14, 1.99, P = 0.004, I<sup>2</sup> = 0%), unadjusted all-cause revision rate (RR 1.44, 95% CI 1.08, 1.90, P = 0.011, I<sup>2</sup> = 91.8%) and adjusted all-cause revision rate (HR 1.21, 95% CI 1.12, 1.31, P < 0.001, I<sup>2</sup> = 0%) in ALBC group were significantly higher than those in non-antibiotic-loaded bone cement (NALBC) group. ALBC group was significantly lower than NALBC group in DIR (OR 0.53, 95% CI 0.39, 0.70, P < 0.0001, I<sup>2</sup> = 57%), (RR 0.506, 95% CI 0.341, 0.751, P = 0.001, I<sup>2</sup> = 0%) and revision for PJI (RR 0.721, 95% CI 0.628, 0.828, P = 0, I<sup>2</sup> = 53%). There was no statistical difference in total infection rate (TIR) between the ALBC group and the NALBC group (OR 0.81, 95% CI 0.51, 1.28, P = 0.37, I<sup>2</sup> = 73%).</p><p><strong>Conclusions: </strong>On the basis of the results of our analysis, we do not believe that ALBC is more effective than NALBC in preventing PJI after primary total joint arthroplasty (PTJA). No statistically significant difference was found on TIR between the two groups, although it was lower in the ALBC group. In addition, the DIR and revision for PJI are significantly lower in the ALBC group, but the results are of low quality, which calls for high-quality and large-sample studies in the future.</p>","PeriodicalId":48603,"journal":{"name":"Journal of Orthopaedics and Traumatology","volume":"26 1","pages":"23"},"PeriodicalIF":3.7000,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12008095/pdf/","citationCount":"0","resultStr":"{\"title\":\"The application of antibiotic-loaded bone cement in preventing periprosthetic joint infection: an umbrella review.\",\"authors\":\"Yangbin Cao, Peiyuan Tang, Hua Chai, Wenbo Ma, Bin Lin, Ying Zhu, Ahmed Abdirahman, Wenfeng Xiao, Jun Zhang, Yusheng Li, Shuguang Liu, Ting Wen\",\"doi\":\"10.1186/s10195-025-00839-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The purpose of this study was to provide thorough, understandable and precise evidence for the clinical use of antibiotic-loaded bone cement (ALBC) in preventing periprosthetic joint infection (PJI).</p><p><strong>Methods: </strong>We evaluated the effectiveness of ALBC in preventing PJI by conducting an umbrella review of existing meta-analysis. Four databases, PubMed/MEDLINE, Cochrane Library, Embase and Web of Science, were searched until May 2024. Two reviewers were reviewers for literature screening, and data were extracted independently. AMSTAR 2 guideline and GRADE were also used for quality evaluation. The clinical outcomes were evaluated for effectiveness by several indicators, including surface infection rate (SIR), deep infection rate (DIR), total infection rate (TIR), unadjusted/adjusted all-cause revision rate, and revision rate for PJI.</p><p><strong>Results: </strong>We synthesized the results of ten meta-analyses. Two meta-analyses had high AMSTAR 2 scores, two had moderate AMSTAR 2 ratings, three had critically low AMSTAR 2 scores, and the remaining meta-analyses had low AMSTAR 2 ratings. 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引用次数: 0
摘要
目的：本研究的目的是为临床使用抗生素骨水泥（ALBC）预防假体周围关节感染（PJI）提供全面、可理解和准确的证据。方法：我们通过对现有荟萃分析进行总括性回顾来评估ALBC预防PJI的有效性。PubMed/MEDLINE、Cochrane Library、Embase和Web of Science四个数据库被检索到2024年5月。2名审稿人为文献筛选审稿人，数据独立提取。采用AMSTAR 2指南和GRADE进行质量评价。通过表面感染率（SIR）、深部感染率（DIR）、总感染率（TIR）、未调整/调整全因修正率、PJI修正率等指标评价临床结果的有效性。结果：我们综合了10项meta分析的结果。2项荟萃分析的AMSTAR 2评分较高，2项荟萃分析的AMSTAR 2评分中等，3项荟萃分析的AMSTAR 2评分极低，其余荟萃分析的AMSTAR 2评分较低。术后手术部位感染及翻修率方面，ALBC组SIR （OR 1.50, 95% CI 1.14, 1.99, P = 0.004, I2 = 0%）、未调整全因翻修率（RR 1.44, 95% CI 1.08, 1.90, P = 0.011, I2 = 91.8%）、调整全因翻修率（HR 1.21, 95% CI 1.12, 1.31, P = 0%）均显著高于非抗生素骨水泥（NALBC）组。ALBC组在DIR （OR 0.53, 95% CI 0.39, 0.70, P 2 = 57%）、PJI修订（RR 0.506, 95% CI 0.341, 0.751, P = 0.001, 2 = 0%）和PJI修订（RR 0.721, 95% CI 0.628, 0.828, P = 0, 2 = 53%）均显著低于NALBC组。ALBC组与NALBC组总感染率（TIR）比较，差异无统计学意义（OR 0.81, 95% CI 0.51, 1.28, P = 0.37, I2 = 73%）。结论：根据我们的分析结果，我们认为ALBC在预防原发性全关节置换术（PTJA）后PJI方面并不比NALBC更有效。两组间TIR差异无统计学意义，ALBC组较低。此外，ALBC组PJI的DIR和修订明显较低，但结果质量较低，需要未来进行高质量、大样本的研究。
The application of antibiotic-loaded bone cement in preventing periprosthetic joint infection: an umbrella review.
Objectives: The purpose of this study was to provide thorough, understandable and precise evidence for the clinical use of antibiotic-loaded bone cement (ALBC) in preventing periprosthetic joint infection (PJI).
Methods: We evaluated the effectiveness of ALBC in preventing PJI by conducting an umbrella review of existing meta-analysis. Four databases, PubMed/MEDLINE, Cochrane Library, Embase and Web of Science, were searched until May 2024. Two reviewers were reviewers for literature screening, and data were extracted independently. AMSTAR 2 guideline and GRADE were also used for quality evaluation. The clinical outcomes were evaluated for effectiveness by several indicators, including surface infection rate (SIR), deep infection rate (DIR), total infection rate (TIR), unadjusted/adjusted all-cause revision rate, and revision rate for PJI.
Results: We synthesized the results of ten meta-analyses. Two meta-analyses had high AMSTAR 2 scores, two had moderate AMSTAR 2 ratings, three had critically low AMSTAR 2 scores, and the remaining meta-analyses had low AMSTAR 2 ratings. In terms of postoperative surgical site infection and revision rate, SIR (OR 1.50, 95% CI 1.14, 1.99, P = 0.004, I2 = 0%), unadjusted all-cause revision rate (RR 1.44, 95% CI 1.08, 1.90, P = 0.011, I2 = 91.8%) and adjusted all-cause revision rate (HR 1.21, 95% CI 1.12, 1.31, P < 0.001, I2 = 0%) in ALBC group were significantly higher than those in non-antibiotic-loaded bone cement (NALBC) group. ALBC group was significantly lower than NALBC group in DIR (OR 0.53, 95% CI 0.39, 0.70, P < 0.0001, I2 = 57%), (RR 0.506, 95% CI 0.341, 0.751, P = 0.001, I2 = 0%) and revision for PJI (RR 0.721, 95% CI 0.628, 0.828, P = 0, I2 = 53%). There was no statistical difference in total infection rate (TIR) between the ALBC group and the NALBC group (OR 0.81, 95% CI 0.51, 1.28, P = 0.37, I2 = 73%).
Conclusions: On the basis of the results of our analysis, we do not believe that ALBC is more effective than NALBC in preventing PJI after primary total joint arthroplasty (PTJA). No statistically significant difference was found on TIR between the two groups, although it was lower in the ALBC group. In addition, the DIR and revision for PJI are significantly lower in the ALBC group, but the results are of low quality, which calls for high-quality and large-sample studies in the future.
期刊介绍：
The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.
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