The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival

The survival of a knee prosthesis is one of the most important indicators of the success or failure of a knee arthroplasty. An intervention that could increase prosthetic survival is the use of antibiotic-loaded bone cement (ALBC) during primary surgery, but the evidence for this is not conclusive....

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Autores: Velasco-Regúlez, Borja|||0000-0003-4718-3388, Gil González, Sergi|||0000-0001-5939-0769, Cerquides Bueno, Jesus|||0000-0002-3752-644X
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:dnet:uabarcelona_::4b88ac9503fe607ac6aa7ca3ed35dadf
Acceso en línea:https://ddd.uab.cat/record/326515
https://dx.doi.org/urn:doi:10.1002/jeo2.70574
Access Level:acceso abierto
Palabra clave:Antibiotic-loaded bone cement
Causal inference
Causal survival analysis
Total knee arthroplasty
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spelling The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survivalVelasco-Regúlez, Borja|||0000-0003-4718-3388Gil González, Sergi|||0000-0001-5939-0769Cerquides Bueno, Jesus|||0000-0002-3752-644XAntibiotic-loaded bone cementCausal inferenceCausal survival analysisTotal knee arthroplastyThe survival of a knee prosthesis is one of the most important indicators of the success or failure of a knee arthroplasty. An intervention that could increase prosthetic survival is the use of antibiotic-loaded bone cement (ALBC) during primary surgery, but the evidence for this is not conclusive. The question of whether such an intervention increases prosthetic survival is a causal one, and yet it has never been addressed with causal methods in the observational studies literature. This constitutes a serious limitation, as there is growing evidence that the best-suited framework for addressing causal questions with observational data is causal inference. In the present study, causal inference methods were employed to answer the research question of whether ALBC increases prosthetic survival. In particular, directed acyclic graphs were used for identification and causal survival forests were used to estimate the effect of interest. The rationale behind these methods is provided in the main text, and technical details are provided in Supporting Information: File S3. Data from the Catalan Arthroplasty Register were analysed. ALBC had an effect of increasing the overall prosthetic survival by 8% after 120 months of follow-up. The intervention had a positive effect across all the subgroups of the population defined by confounding variables, but the effect was greater in men, young patients, patients with rheumatoid arthritis or obesity, and patients who smoked or abused alcohol. The chosen causal assumptions had an impact on the obtained results, empirically showing the importance of using a causal framework. ALBC increased knee prosthesis survival among patients in the Catalan public healthcare system. Causal inference methods are the most appropriate for answering causal questions about the effect of ALBC on prosthetic survival when the analysed data are observational. Level III. 22025-01-0120252025-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/326515https://dx.doi.org/urn:doi:10.1002/jeo2.70574reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengAgencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2022-136787NB-I00Agencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2019-104156GB-I00European Commission https://doi.org/10.13039/501100000780 101060693European Commission https://doi.org/10.13039/501100000780 101057693European Commission https://doi.org/10.13039/501100000780 952026open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:uabarcelona_::4b88ac9503fe607ac6aa7ca3ed35dadf2026-06-06T12:50:31Z
dc.title.none.fl_str_mv The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
title The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
spellingShingle The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
Velasco-Regúlez, Borja|||0000-0003-4718-3388
Antibiotic-loaded bone cement
Causal inference
Causal survival analysis
Total knee arthroplasty
title_short The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
title_full The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
title_fullStr The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
title_full_unstemmed The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
title_sort The first causal inference analysis of the Catalan Arthroplasty Register shows a positive effect of antibiotic-loaded bone cement on knee prosthesis survival
dc.creator.none.fl_str_mv Velasco-Regúlez, Borja|||0000-0003-4718-3388
Gil González, Sergi|||0000-0001-5939-0769
Cerquides Bueno, Jesus|||0000-0002-3752-644X
author Velasco-Regúlez, Borja|||0000-0003-4718-3388
author_facet Velasco-Regúlez, Borja|||0000-0003-4718-3388
Gil González, Sergi|||0000-0001-5939-0769
Cerquides Bueno, Jesus|||0000-0002-3752-644X
author_role author
author2 Gil González, Sergi|||0000-0001-5939-0769
Cerquides Bueno, Jesus|||0000-0002-3752-644X
author2_role author
author
dc.subject.none.fl_str_mv Antibiotic-loaded bone cement
Causal inference
Causal survival analysis
Total knee arthroplasty
topic Antibiotic-loaded bone cement
Causal inference
Causal survival analysis
Total knee arthroplasty
description The survival of a knee prosthesis is one of the most important indicators of the success or failure of a knee arthroplasty. An intervention that could increase prosthetic survival is the use of antibiotic-loaded bone cement (ALBC) during primary surgery, but the evidence for this is not conclusive. The question of whether such an intervention increases prosthetic survival is a causal one, and yet it has never been addressed with causal methods in the observational studies literature. This constitutes a serious limitation, as there is growing evidence that the best-suited framework for addressing causal questions with observational data is causal inference. In the present study, causal inference methods were employed to answer the research question of whether ALBC increases prosthetic survival. In particular, directed acyclic graphs were used for identification and causal survival forests were used to estimate the effect of interest. The rationale behind these methods is provided in the main text, and technical details are provided in Supporting Information: File S3. Data from the Catalan Arthroplasty Register were analysed. ALBC had an effect of increasing the overall prosthetic survival by 8% after 120 months of follow-up. The intervention had a positive effect across all the subgroups of the population defined by confounding variables, but the effect was greater in men, young patients, patients with rheumatoid arthritis or obesity, and patients who smoked or abused alcohol. The chosen causal assumptions had an impact on the obtained results, empirically showing the importance of using a causal framework. ALBC increased knee prosthesis survival among patients in the Catalan public healthcare system. Causal inference methods are the most appropriate for answering causal questions about the effect of ALBC on prosthetic survival when the analysed data are observational. Level III.
publishDate 2025
dc.date.none.fl_str_mv 2
2025-01-01
2025
2025-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/326515
https://dx.doi.org/urn:doi:10.1002/jeo2.70574
url https://ddd.uab.cat/record/326515
https://dx.doi.org/urn:doi:10.1002/jeo2.70574
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Agencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2022-136787NB-I00
Agencia Estatal de Investigación https://doi.org/10.13039/501100011033 PID2019-104156GB-I00
European Commission https://doi.org/10.13039/501100000780 101060693
European Commission https://doi.org/10.13039/501100000780 101057693
European Commission https://doi.org/10.13039/501100000780 952026
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
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collection Dipòsit Digital de Documents de la UAB
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