Antibiotic prophylaxis in total hip arthroplasty -: Effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register
Antibiotic prophylaxis in total hip arthroplasty -: Effects of antibiotic prophylaxis systemically and in bone cement on the revision rate of 22,170 primary hip replacements followed 0-14 years in the Norwegian Arthroplasty Register
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DOI：
10.1080/00016470310018135
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发表时间：
2003-12-01
期刊：
影响因子：
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通讯作者：
Havelin, LI
中科院分区：
文献类型：
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作者：
Engesæter, LB;Lie, SA;Havelin, LI
在挪威关节成形术登记处1987-2001年间的数据中，我们系统地和骨水泥中研究了抗生素预防对骨水泥型全髋关节置换术(THAs)翻修率的影响。为了具有可比性，只有因原发性骨关节炎而行全髋关节置换术，使用有文献记载的良好效果的骨水泥植入物，以及高粘度的骨水泥被包括在内。如果给予全身抗生素预防，只选择头孢菌素或青霉素的手术。COX估计的生存相对翻修风险(RR)在调整性别、年龄、水泥品牌、全身抗生素预防类型、假体类型、手术室类型和手术持续时间的组间差异后显示。在所研究的22,170个THA中，696个THA(3.1%)被修正，440个(2.0%)为无菌性松动，102个(0.5%)为深度感染。我们发现，当系统地和水泥中同时给予抗生素预防时，复发的风险最低(15,676个THAs)。与这种联合方案相比，只接受系统预防的患者(5,960个THAs)的翻修率是以所有翻修原因为终点的1.4倍(p=0.001)，无菌松动(p=0.02)的1.3倍，感染为终点的1.8倍(p=0.01)。在联合抗生素方案中，手术当天给予抗生素4次(2,194个THAs)的结果好于在手术当天使用一次(1,424 THAs)(p<；0.001)，两次(2,680 THa)(p<；0.001)，或3倍(5,522个临屋区)(p=0.02)。接受系统预防1、2或3次的患者，以所有翻修原因为终点，翻修率为1.8~3.5倍，无菌松动为1.5~3.1倍，感染为2.7~6.8倍。当我们在1天内比较4次系统预防时，接受系统预防2天(1,928次)或3天(717次)的患者没有进一步的改善。在只包括Charnley假体的数据子集中，我们获得了类似的结果。这项观察性研究表明，当系统预防抗生素和在骨水泥中使用抗生素时，以及如果在手术当天全身使用抗生素4次时，效果最好。
We studied the effects of antibiotic prophylaxis, systemically and in bone cement, on the revision rate of cemented total hip arthroplasties (THAs) in data from the Norwegian Arthroplasty Register during the period 1987-2001. To have comparable groups, only THAs performed because of primary osteoarthritis, using cemented implants with documented good results, and high-viscosity cement were included. If systemic antibiotic prophylaxis had been given, only operations with cephalosporin or penicillin were selected.Cox-estimated survival relative revision risks (RR) are presented with adjustment for differences among groups in gender, age, cement brand, type of systemic antibiotic prophylaxis, type of prosthesis, type of operating room, and duration of the operation.Of 22,170 THAs studied, 696 THAs (3.1%) were revised, 440 (2.0%) for aseptic loosening and 102 (0.5%) for deep infection. We found the lowest risk of revision when the antibiotic prophylaxis was given both systemically and in the cement (15,676 THAs). Compared to this combined regime, patients who received antibiotic prophylaxis only systemically (5,960 THAs) had a 1.4 times higher revision rate with all reasons for revision as endpoint (p = 0.001), 1.3 times higher with aseptic loosening (p = 0.02) and 1.8 times higher with infection as the endpoint (p = 0.01).With the combined antibiotic regime, the results were better if antibiotics were given 4 times on the day of surgery (2,194 THAs), as compared to once (1,424 THAs) (p < 0.001), twice (2,680 THAs) (p < 0.001), or 3 times (5,522 THAs) (p = 0.02). Those who received systemic prophylaxis a single day 1, 2 or 3 times, as compared to 4 times, had a revision rate 1.8-3.5 times higher with all reasons for revision as endpoint, 1.5-3.1 times higher with aseptic loosening, and 2.7-6.8 times higher with infection. When we compared systemic prophylaxis 4 times in 1 day, no further improvement resulted in those given systemic prophylaxis for 2 days (1,928 THAs) or 3 days (717 THAs). In a subset of data including only the Charnley prosthesis, we obtained similar results.This observational study shows that the best results were recorded when antibiotic prophylaxis was given both systemically and in the bone cement, and if the systemic antibiotic was given 4 times on the day of surgery.