Periprosthetic Joint Infection After Total Knee Arthroplasty With or Without Antibiotic Bone Cement.

Importance: Despite increased use of antibiotic-loaded bone cement (ALBC) in joint arthroplasty over recent decades, current evidence for prophylactic use of ALBC to reduce risk of periprosthetic joint infection (PJI) is insufficient. Objective: To compare the rate of revision attributed to PJI following primary total knee arthroplasty (TKA) using ALBC vs plain bone cement. Design, Setting, and Participants: This international cohort study used data from 14 national or regional joint arthroplasty registries in Australia, Denmark, Finland, Germany, Italy, New Zealand, Norway, Romania, Sweden, Switzerland, the Netherlands, the UK, and the US. The study included primary TKAs for osteoarthritis registered from January 1, 2010, to December 31, 2020, and followed-up until December 31, 2021. Data analysis was performed from April to September 2023. Exposure: Primary TKA with ALBC vs plain bone cement. Main Outcomes and Measures: The primary outcome was risk of 1-year revision for PJI. Using a distributed data network analysis method, data were harmonized, and a cumulative revision rate was calculated (1 - Kaplan-Meier), and Cox regression analyses were performed within the 10 registries using both cement types. A meta-analysis was then performed to combine all aggregated data and evaluate the risk of 1-year revision for PJI and all causes. Results: Among 2 168 924 TKAs included, 93% were performed with ALBC. Most TKAs were performed in female patients (59.5%) and patients aged 65 to 74 years (39.9%), fully cemented (92.2%), and in the 2015 to 2020 period (62.5%). All participating registries reported a cumulative 1-year revision rate for PJI of less than 1% following primary TKA with ALBC (range, 0.21%-0.80%) and with plain bone cement (range, 0.23%-0.70%). The meta-analyses based on adjusted Cox regression for 1 917 190 TKAs showed no statistically significant difference at 1 year in risk of revision for PJI (hazard rate ratio, 1.16; 95% CI, 0.89-1.52) or for all causes (hazard rate ratio, 1.12; 95% CI, 0.89-1.40) among TKAs performed with ALBC vs plain bone cement. Conclusions and Relevance: In this study, the risk of revision for PJI was similar between ALBC and plain bone cement following primary TKA. Any additional costs of ALBC and its relative value in reducing revision risk should be considered in the context of the overall health care delivery system.

Effects of Covid-19 on the elective surgery: an approach based on the case of the Italian Province of Bolzano.

BACKGROUND: As of February 2020, the rise of COVID-19 cases led to significant pressures in the Northern parts of Italy, including the province of Bolzano (a small territorial reality on the border between Italy and Austria), and left the Italian National Health System (NHS) unprepared for the initial wave of the SARS-CoV-2 pandemic. OBJECTIVE/METHODS: By dividing the analyses into two phases, the study assesses the effect of COVID-19 for the years 2018-2019 and 2020-2021. The first phase highlights the hospitalization rates in the Province of Bolzano in comparison to other Italian regions. In the second step, the Systematic Component of Variation (SCV) has been applied to calculate the differences between the admission rates for the elective surgery (tonsillectomy, vein stripping, hip replacement, knee replacement, and arthroscopy) in the four health districts (HDs) of the Province of Bolzano. RESULTS: Overall, the findings demonstrate that the effect of COVID-19 cases has resulted in a 20% reduction in hospitalization rates. A variation of less than 30% for knee and hip replacements and up to 75% for vein stripping is seen for elective surgeries. According to the SCV values for each elective procedure, the results indicate comparable levels of variation across the two time periods, with tonsillectomy showing the lowest levels of variation, arthroscopy and vein stripping having the highest levels, hip replacement having a high level and knee replacement having a low-medium level. CONCLUSIONS: The data show no significant changes in the variation between the four HDs in the province of Bolzano, suggesting that the COVID-19 cases have a proportionate impact on hospitalization rates.