{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:21:28Z","timestamp":1790360488462,"version":"4.1.0"},"reference-count":43,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2020,6,28]],"date-time":"2020-06-28T00:00:00Z","timestamp":1593302400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Prosthetic joint infection (PJI) is a serious complication of joint replacement surgeries. Surgeons often take extra measures to reduce the risk of PJI. Whilst many studies have compared between cemented, cementless and hybrid fixation (femoral cementless, tibial cemented), most focus on survivorship, clinical and function outcome scores as primary endpoints. This meta\u2010analysis aims to study the association between fixation methods and risk of PJI in primary total knee arthroplasty (TKA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review and network meta\u2010analysis of randomized controlled trials (RCT) were performed according to Preferred Reporting Items for Systematic reviews and Meta\u2010Analyses guidelines. Data from studies assessing prevalence of PJI in each fixation type were extracted and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve RCT comprising a total of 1573 knees were included. Six RCT compared between cemented (<jats:italic>n<\/jats:italic> =\u2009486 knees) and cementless (<jats:italic>n<\/jats:italic> =\u2009440 knees) fixation, while six RCT compared between hybrid (<jats:italic>n<\/jats:italic> =\u2009324 knees) and cementless (<jats:italic>n<\/jats:italic> =\u2009323 knees) fixation. Network meta\u2010analysis did not reveal any fixation type that significantly increased the infection rate in TKA. Rate of all infection was lowest in cemented TKA as compared to cementless (odds ratio (OR) 0.90, 95% confidence interval (CI) 0.35\u20132.28) and hybrid (OR 0.63, 95%CI 0.13\u20132.99) TKA. Rate of PJI requiring revision surgery was lowest in cementless TKA as compared to cemented (OR 0.89, 95%CI 0.30\u20132.41) and hybrid (OR 0.57, 95%CI 0.09\u20132.71) TKA. Rate of PJI not requiring revision surgery was lowest in cemented TKA as compared to hybrid (OR 0.56, 95%CI 0.06\u20136.10) and cementless (OR 0.55, 95% 0.14\u20135.63).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Unlike total hip arthroplasties, fixation method is not a predisposing risk factor for infections in TKA. However, this meta\u2010analysis may not have sufficient statistical power to show a significant difference between fixation types. It is recommended that prophylactic precautions against other known risk factors for infection should still be clinically practiced. Level of evidence: Level I, meta\u2010analysis of randomized controlled trials.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.16078","type":"journal-article","created":{"date-parts":[[2020,6,28]],"date-time":"2020-06-28T18:09:40Z","timestamp":1593367780000},"page":"1289-1298","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of infection in cemented, cementless and hybrid primary total knee arthroplasty: a network meta\u2010analysis and systematic review of randomized clinical trials"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2372-7742","authenticated-orcid":false,"given":"James","family":"Onggo","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Box Hill Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Onggo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Flinders Medical Centre  Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5940-3555","authenticated-orcid":false,"given":"Kevin","family":"Phan","sequence":"additional","affiliation":[{"name":"Department of Medicine Liverpool Hospital  Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Flinders Medical Centre  Adelaide South Australia Australia"},{"name":"Department of Orthopaedic Surgery Repatriation General Hospital  Adelaide South Australia Australia"},{"name":"Department of Orthopaedics The International Musculoskeletal Research Institute Inc.  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