The application of antibiotic-loaded bone cement in preventing periprosthetic joint infection: an umbrella review

被引：0
作者：
Yangbin Cao [1 ]
Peiyuan Tang [3 ]
Hua Chai [1 ]
Wenbo Ma [2 ]
Bin Lin [3 ]
Ying Zhu [3 ]
Ahmed Abdirahman [3 ]
Wenfeng Xiao [3 ]
Jun Zhang [1 ]
Yusheng Li [2 ]
Shuguang Liu [1 ]
Ting Wen [2 ]
机构：
[1] Department of Orthopedics, Xiangya Hospital, Central South University, Hunan
[2] National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha
[3] Xiangya School of Medicine, Central South University, Changsha
[4] The First People’s Hospital of Changde City, Changde Hospital, Xiangya Medical College, Central South University, Changsha
[5] Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Shaanxi, Xi’an
来源：
Journal of Orthopaedics and Traumatology | / 26卷 / 1期
基金：
中国国家自然科学基金;
关键词：
Antibacterial agents; Antibiotic prophylaxis; Bone cements; Prosthesis-related infections; Total joint arthroplasty;
D O I：
10.1186/s10195-025-00839-w
中图分类号：
学科分类号：
摘要：
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. © The Author(s) 2025.
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