Use of dual antibiotic loaded cement does not reduce surgical site infection rates in patients undergoing hemiarthroplasty

1. Deep surgical site infection at 90 days was 1.7% in the single-antibiotic group versus 1.2% in the dual-antibiotic loaded cement group, with no significant differences between groups.

2. Quality of life, mobility, and mortality at 120 days were comparable between both groups.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Hip fracture is a common injury in the elderly that necessitates hospital, and often operative, management. Although surgical site infections are common, mixed evidence exists regarding the use of antibiotic-loaded bone cement in hemiarthroplasty. This randomized trial aimed to compare the incidence of deep surgical site infection in patients receiving high-dose dual-antibiotic loaded cement versus standard care single-antibiotic loaded cement for hip fractures. The primary outcome of this study was the rate of deep surgical site infection at 90 days post-randomization, while key secondary outcomes were quality of life, mortality, and mobility at 120 days. According to study results, the use of high-dose dual-antibiotic loaded cement did not reduce the rate of deep surgical site infection in elderly patients undergoing hemiarthroplasty nor were there any differences in mortality. This study was strengthened by a large sample size from across the UK, thus increasing its validity.

Click to read the study in The Lancet

Relevant Reading: Cemented or Uncemented Hemiarthroplasty for Intracapsular Hip Fracture

In-depth [randomized-controlled trial]: Between Aug 17, 2018, and Aug 5, 2021, 5247 patients were screened for eligibility across 26 hospitals in the UK. Included were patients ≥ 60 years old with a displaced intracapsular hip fracture who were scheduled to undergo a hemiarthroplasty. Altogether, 4936 patients (2453 to single-antibiotic loaded cement and 2483 to high-dose dual-antibiotic loaded cement) were included in the final analysis. The primary outcome of surgical site infection at 90 days was comparable between groups (1.7% in single-antibiotic vs. 1.2% in high-dose dual-antibiotic, adjusted odds ratio [aOR] 1.43, 95% confidence interval [CI] 0.87-2.35, p=0.16). This was also the case for secondary outcomes such as quality of life and mortality (20.7% in the single-antibiotic group vs. 19.2% in the dual-antibiotic loaded cement group; aOR 1.06 [0.92-1.23]). Findings from this study suggest that high-dose dual-antibiotic loaded cement did not reduce deep surgical site infection in older patients undergoing hemiarthroplasty for intracapsular hip fractures.

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