http://hdl.handle.net/11434/5 Sat, 23 May 2026 02:11:53 GMT 2026-05-23T02:11:53Z http://hdl.handle.net/11434/2427 Title: Association of antioxidant-added highly cross-linked polyethylene on revision risk: a registry-based study of 198,073 total hip replacements from the Australian Orthopaedic Association National Joint Replacement Registry between 2014 and 2023. Epworth Authors: de Steiger, Richard Abstract: Background and purpose: Adding antioxidant to highly cross-linked polyethylene (XLPE) is proposed to improve oxidation resistance and decrease wear in total hip replacements (THR), but long-term performance is unknown. We aimed to compare the revision rates of THR using cementless acetabular components where the insert was made of either XLPE with antioxidant (AOXLPE) or XLPE, using data from a large national registry. Methods: The population was THR from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) in the 10-year period 2014–2023 with modular cementless acetabular components and ceramic or metal femoral heads used for osteoarthritis. We compared primary THR using XLPE with antioxidant (AOXLPE) acetabular inserts with XLPE acetabular inserts. The outcome measured was all-cause revision. Cumulative percentage revision (CPR) was calculated using the Kaplan–Meier method, and comparisons made using Cox proportional hazards models. Results: There were 198,073 THRs, of which 35,309 had AOXLPE inserts. There were 769 and 4,327 revisions with AOXLPE and XLPE inserts, respectively. While there was no early difference, the AOXLPE group had a lower revision rate after 3 years (HR 0.64, 95% confidence interval [CI] 0.48–0.84). When adjusted for multiple factors the AOXLPE group still had a lower revision rate after 3 years (HR 0.63, CI 0.47–0.83). Revisions for loosening, wear-related causes, and fracture were proportionately lower in the AOXLPE group, but no difference was found with revisions for dislocation/instability or infection. Conclusion: While there was no early difference, THR with AOXLPE acetabular inserts had a lower revision rate after 3 years than XLPE. This suggests a possible clinical benefit using AOXLPE but the difference may, in part, be related to the associated femoral or acetabular components. Thu, 01 Jan 2026 00:00:00 GMT http://hdl.handle.net/11434/2427 2026-01-01T00:00:00Z http://hdl.handle.net/11434/2398 Title: Fifteen-year mortality following periprosthetic joint infection in total knee arthroplasty: A registry study of 8,642 revisions for infection. Epworth Authors: de Steiger, Richard Abstract: Background: Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a serious complication associated with notable loss of function, impaired quality of life, and excess short-term mortality. In this study, we aimed to report the impact of PJI on long-term mortality and its associated risk factors. Methods: Using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), we used Kaplan-Meier estimates of survivorship and standardized mortality ratios (SMRs) based on Australian period life tables to describe mortality rates following revision for PJI, aseptic revisions (excluding those for fracture), and unrevised primary TKA. Additionally, hazard ratios (HRs) were calculated with multivariable proportional hazard models to assess the impact of the risk factors of age, gender, comorbidities, and minor versus major revisions. Results: Among 867,113 TKA procedures overall, there were 8,642 first revisions for PJI and 25,328 aseptic first revisions. At 5, 10, and 15 years, 16.1%, 34.4%, and 53.4% of patients with revision for PJI had died. When compared with a matched population, the SMR for revision for PJI was 1.33 (95% confidence interval [CI]: 1.28 to 1.39); for aseptic revision, 0.84 (95% CI: 0.82 to 0.87); and for unrevised primary TKA, 0.79 (95% CI: 0.78 to 0.79). Increasing age and higher American Society of Anesthesiologists (ASA) scores were significant mortality risk factors. Major revisions for PJI were not associated with a greater mortality risk compared with minor revisions for PJI. Conclusions: Patients with revision for PJI had a 33% greater-than-expected mortality. There was a high mortality in the early postoperative period, and the excess mortality risk persisted beyond 15 years. Increasing age and higher ASA scores were associated with increased mortality. Fri, 01 Aug 2025 00:00:00 GMT http://hdl.handle.net/11434/2398 2025-08-01T00:00:00Z http://hdl.handle.net/11434/2396 Title: Antibiotic-loaded bone cement and risk of infection after knee arthroplasty in high-risk patients: A register-based meta-analysis. Epworth Authors: de Steiger, Richard Abstract: Background: The use of antibiotic-loaded bone cement (ALBC) in primary total knee arthroplasty (TKA) is debated. Some argue that ALBC might only be justified in high-risk patients. This study assessed the effectiveness of ALBC vs. plain bone cement (PBC) in reducing risk of revision for periprosthetic joint infection (PJI) in TKA patients considered to have a high risk of infection. Methods: Cohort study of primary TKAs in 11 national or regional arthroplasty registries from 2010 to 2020. The 1-year risk of revision for PJI in TKAs with ALBC vs. PBC among patients with high American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and/or diabetes was compared. Cumulative percent revision (1 minus Kaplan-Meier) based on 685,818 TKAs and Cox regression analyses (adjusted Hazard Rate Ratios [aHRRs]) were performed for TKAs with ALBC (reference) vs. PBC restricted to the following high-risk subgroups of patients: (1) ASA ≥3 (n = 335,612 vs. 35,997), (2) BMI ≥35 (n = 278,927 vs. 24,737), (3) ASA ≥3 and BMI ≥35 (n = 99,407 vs. 11,407), (4) diabetes (n = 38,341 vs. 21,838), and (5) ASA ≥3, BMI ≥35, and diabetes (n = 3,347 vs. 4,261). Advanced distributed meta-analyses were performed to combine all aggregate data and assess 1-year risk of revision for PJI. Results: Each registry reported a 1-year cumulative percent revision of ≤1.6% for PJI following TKAs both for ALBC and PBC in all high-risk subgroups. Similar 1-year risks of revision for PJI were found in TKAs with ALBC (reference) and PBC among patients with ASA ≥3 (aHRR: 1.09; 95% CI, 0.90-1.31); BMI ≥35 (1.06; 0.54-2.12); ASA ≥3 and BMI ≥35 (1.12; 0.83-1.50); diabetes (0.95; 0.74-1.20); and ASA ≥3, BMI ≥35, and diabetes (1.40; 0.86-2.29). Conclusions and Relevance: Similar 1-year revision risk of PJI was found for TKAs with ALBC vs. PBC in high-risk patients. Confirmation of the efficacy of ALBC in high-risk TKA patients needs to be evaluated in clinical trials. Mon, 01 Sep 2025 00:00:00 GMT http://hdl.handle.net/11434/2396 2025-09-01T00:00:00Z http://hdl.handle.net/11434/2320 Title: Is there a threshold limit for body mass index for patients undergoing primary total knee or total hip arthroplasty? World Expert Meeting in Arthroplasty 2024. Epworth Authors: De Steiger, Richard Abstract: Is There a Threshold Limit for Body Mass Index for Patients Undergoing Primary Total Knee or Total Hip Arthroplasty? Response/Recommendation: Although most studies show a higher complication rate in patients who have a higher body mass index (BMI), we are unable to determine an exact threshold for BMI in patients undergoing primary total joint arthroplasty (TJA). Level of Evidence: Moderate. Expert Vote: Agree (77.8%), Disagree (13.7%), Abstain (8.5%). Tue, 01 Oct 2024 00:00:00 GMT http://hdl.handle.net/11434/2320 2024-10-01T00:00:00Z