The use of antibiotic-loaded bone cement and systemic antibiotic prophylactic use in 2,971,357 primary total knee arthroplasties from 2010 to 2020: an international register-based observational study among countries in Africa, Europe, North America, and Oceania.

BACKGROUND AND PURPOSE: Antibiotic-loaded bone cement (ALBC) and systemic antibiotic prophylaxis (SAP) have been used to reduce periprosthetic joint infection (PJI) rates. We investigated the use of ALBC and SAP in primary total knee arthroplasty (TKA). PATIENTS AND METHODS: This observational study is based on 2,971,357 primary TKAs reported in 2010-2020 to national/regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, the Netherlands, New Zealand, Norway, Romania, South Africa, Sweden, Switzerland, the UK, and the USA. Aggregate-level data on trends and types of bone cement, antibiotic agents, and doses and duration of SAP used was extracted from participating registries. RESULTS: ALBC was used in 77% of the TKAs with variation ranging from 100% in Norway to 31% in the USA. Palacos R+G was the most common (62%) ALBC type used. The primary antibiotic used in ALBC was gentamicin (94%). Use of ALBC in combination with SAP was common practice (77%). Cefazolin was the most common (32%) SAP agent. The doses and duration of SAP used varied from one single preoperative dosage as standard practice in Bolzano, Italy (98%) to 1-day 4 doses in Norway (83% of the 40,709 TKAs reported to the Norwegian arthroplasty register). CONCLUSION: The proportion of ALBC usage in primary TKA varies internationally, with gentamicin being the most common antibiotic. ALBC in combination with SAP was common practice, with cefazolin the most common SAP agent. The type of ALBC and type, dose, and duration of SAP varied among participating countries.

The usage of image trigonometry in bone measurements.

The entire musculo-skeletal system responds dynamically to stresses and strains applied to it. Restoring normal biomechanics contributes to the normal function that ensures that physiological stresses and strains are preserved. Appropriate preoperative planning is mandatory to restore normal biomechanics at reconstructive surgery. Effective preoperative planning depends on the ability to reproducibly make accurate measurements of lengths and angles from plain radiographs. Measurement has become an integral part of orthopaedics to define morphological abnormality, to plan for reconstruction and for comparative research. The most prevalent method of measurement is usually based on lines drawn on radiographs with no accurate reference to the actual geometry of the structures. This two-dimensional projection of an asymmetrical three-dimensional structure leads to inaccuracy and consequently to a compromise in the overall precision of many procedures. In addition it is also difficult to monitor the progression of disease as the exact relationship of the bones and joints to each other, and to prosthetics, cannot be accurately recorded. This paper presents a method of digitally measuring relevant bone parameters in a geometric manner in order to achieve accurate, repeatable measurements.