Total hip replacement is the most successful treatment modern healthcare can offer patients to regain quality of life. Periprosthetic joint infection (PJI) is the most common and devastating complication after total hip replacement (THR). Between 0.5 to 2% of primary THR (first time hip replacement), and 8-10% of revision THR (replacement of a hip prosthesis) will become infected.1 The introduction of local antibiotics blended into bone cement has led to a reduction in postoperative infection in primary THR by half.2 Unfortunately, cement can't always be used in relevant quantities.
The number of primary and revision surgeries of the hip is projected to increase dramatically. Therefore, the need for a feasible infection prophylaxis that is applicable for complex primary and revision THR in addition to antibiotics loaded cement is urgent.
Impacted morselized bone allograft is often used in (revision) THR to fill bone defects. Morselized allograft has been used as a carrier for local antibiotic treatment in multiple pilot studies and appears to be an attractive and effective treatment option, both for already infected joints and as a prophylactic measure in high-risk patients (e.g. THR revision surgeries). Nonetheless, a pivotal trial to support its use in THR is lacking. The aim of this pragmatic randomized controlled double blinded drug trial is to investigate whether antibiotic impregnated bone graft (AIBG) decreases the risk of infection after hip arthroplasty compared to controls treated with placebo impregnated bone graft. Patients scheduled for elective THR will be randomized to receive AIBG or a placebo impregnated bone graft. The primary outcome variable will be the number of re-operations due to infections and PJI diagnoses 2 years postoperative.
Age ≥ 18 years
Hip arthroplasty requiring bone graft
Willing to provide informed consent.
For women of childbearing potential; a negative pregnancy test prior to reoperation.
Ongoing prosthetic joint infection
Known allergies and contraindications for the use of vancomycin or tobramycin
Mental inability, reluctance, or language difficulties that according to investigator judgement, result in difficulty understanding the meaning of study participation
Expected difficulties to complete 2-year follow-up
Parallel
Vancomycin + Tobramycin
Drug1 g vancomycin (powder) diluted in 8 ml tobramycin (40 -80mg/ml). Added to the prepared allograft before the allograft is used during the revision surgery.
Saline
DrugAs a placebo added to the allograft.
Reoperation due to infection or diagnosed PJI with bacteria that are sensitive to either vancomycin or tobramycin, in the same hip joint, within two years after hip arthroplasty.
Reoperation due to infection or diagnosed PJI 2 years of revision surgery.
Time and cause for reoperation for any reason within 2 and 5 years
Time and cause for reoperation for any reason within 2 and 5 years
Time and cause for implant revision due to any reason within 2 and 5 years
Time and cause for implant revision due to any reason within 2 and 5 years
Type of microbe and antibiotic resistance pattern for cases complicated with postoperative infection
Type of microbe and antibiotic resistance pattern for cases complicated with postoperative infection
Differences between the two experimental groups regarding the frequencies of adverse events
Differences between the two experimental groups regarding the frequencies of adverse events
Differences between the two experimental groups regarding the rates of revision due to aseptic loosening
Differences between the two experimental groups regarding the rates of revision due to aseptic loosening
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University Hospital, Linkoeping
Lead sponsor
Region Östergötland
Collaborator
The Swedish Research Council
Collaborator
