The use of PALACOS R+G in the prevention of PJI has an extremely favourable cost-efficiency profile when used routinely in cemented hip and knee arthroplasties
The use of PALACOS R+G antibiotic-loaded bone cement (ALBC) has proven to be effective in preventing periprosthetic joint infection (PJI) after total hip (THA) and knee arthroplasty (TKA). It prevents infections from the outset and consequently reduces revision rates. The economic benefit of using ALBC as standard treatment has been considered controversial. However, recent data reveals a significant cost–saving potential using PALACOS R+G.
Costs are preventing adoption of routine ALBC use
Data from the Norwegian arthroplasty registry looked at 22,170 hip arthroplasties between 1987 and 2001, and a 1.8-fold decrease in the risk of infection was recorded when ALBC was used in cemented hip arthroplasties . Similar results were obtained in a series of 43,149 primary and revision knee arthroplasties based on the Finnish arthroplasty registry .
However, the added costs of using ALBC has prevented its adoption in routine use. Therefore, researchers from the General University Hospital Gregorio Marañon (Madrid, Spain) conducted a study  in more than 2,500 patients subjected to THA, partial hip arthroplasty and TKA between 2009 and 2012, to calculate the costs of the use of ALBC along with the savings per case of PPI avoided. The minimum follow-up for discarding PPI was two years.
Study reveals economic benefit using PALACOS R+G
The Spanish study led by Pablo Sanz-Ruiz, orthopaedic trauma surgeon at the department of traumatology and orthopaedic surgery looked at two groups: before (2009-2010) and after the introduction of ALBC (2011-2012).
The risks of PJI associated with each type of surgery in each group were determined and compared. As ALBC, the hospital used PALACOS R+G from Heraeus Medical, containing 0.5 g of gentamycin in all cases of cemented partial (PHA) and total hip arthroplasty (THA) and total knee arthroplasty (TKA). Patients subjected to THA without cemented implants were used as controls, and possible bias associated with changes in infection rates during the study period and other variables were controlled.
The results were quite clear: Following the introduction of ALBC, a global decrease of 57 per cent was observed in the risk of PPI (p=0.001). By type of surgery, the decrease was 60.6 per cent in the case of TKA (p=0.019) and 72.6 per cent in the case of cemented hip arthroplasty (partial and total; p=0.009). The total savings associated with the use of ALBC amounted to EUR 1,123,846 (i.e. EUR 992 per patient): EUR 440,412 after TKA (i.e. EUR 801 per patient) and EUR 686,644 after cemented hip arthroplasty (i.e. EUR 2,672 per patient).
Cost savings could be applied throughout Europe
The figures are from Spain, but the cost savings can be applied to other European countries too, as the extraordinary expenses caused by a periprosthetic infection and the following revision usually are not fully covered by current reimbursement systems. As a result, they lead to huge deficits.
For example, in Germany the average costs associated with an infected THA or TKA is about EUR 29,300, but the reimbursement code only covers about EUR 16,600. This causes a deficit of approximately EUR 12,600 per case that needs to be covered by the hospital. And, according to Corvec et al. , every revision bears an even higher risk for re-revision if not treated sufficiently because the infection is not fully eradicated.
In conclusion, sufficient data reinforces the evidence on the usefulness of PALACOS R+G in the prevention of PPI and has an extremely favourable cost-efficiency profile when used routinely in cemented hip and knee arthroplasties.
- Engesaeter LB et al.: Acta Orthop Scand 2003;74(6):644.
- Jamsen E et al.: J Bone Joint Surg Am 2009;91(1):38.
- Sanz-Ruiz et al.: J Arthroplasty 32 (4), 1095-1099.
- Corvec S. et al.: Int J Artif Organs 2012; 35; 923-934; Zimmerli W, Trampuz A., Ochsner PE et al.: N Engl J Med 2004; 351: 1645-1654; Malchau H et al.: J Bone Joint Surg Am 2002; 84-A Suppl 2: p. 2-20.