Dual antibiotic-loaded cement bests single antibiotic-loaded cement for reducing infection rates in hip surgeries: study

Bone fractures often require arthroplasty, which carries the risk of surgical site infections (SSIs) and prosthetic joint infections (PJIs). Antibiotic-loaded bone cement (ALBC) is commonly used to reduce these risks. Dual antibiotic-loaded cement (DALC) has been proposed as a more effective option compared to single antibiotic-loaded cement (SALC).

Ahmed E A et al conducted a systematic review and meta-analysis aimed to compare the efficacy and safety of DALC and SALC in preventing infections and related outcomes in arthroplasty.

The authors conducted a systematic review and meta-analysis comparing DALC and SALC in patients undergoing hip or knee arthroplasty for fractures. The primary outcome was infection rate (SSI and PJI), with secondary outcomes including re-revision rates and mortality. Databases searched included PubMed, Cochrane Library, Scopus, and Google Scholar. Data synthesis was performed using Review Manager Software (RevMan 5.4, Cochrane Methods, London, UK), and odds ratios (OR) with 95% confidence intervals (CI) were calculated.

Key findings of the study were:

• Nine studies comprising 55,672 patients were included. Eight studies focused on hip arthroplasty, and four included knee surgeries.

• In hip arthroplasty, DALC significantly reduced infection rates compared to SALC (OR, 0.64; 95% CI, 0.49 to 0.83; P = 0.001), with moderate heterogeneity (I² = 52%). However, no significant difference was found in knee arthroplasty (OR, 1.21; 95% CI, 0.87 to 1.70; P = 0.26).

• Overall, DALC showed a significant reduction in infection rates (OR, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). DALC also significantly reduced deep surgical site infections in hip surgeries (OR, 0.46; 95% CI, 0.33 to 0.66; P < 0.001).

• No significant differences were observed in re-revision rates for either hip or knee arthroplasty. Mortality rates were also not significantly different between DALC and SALC.

The authors concluded that – “The study reveals that dual antibiotic-loaded cement (DALC) is more effective in reducing infection rates, especially in hip surgeries, than single antibiotic-loaded cement (SALC). DALC reduces deep surgical site infections and prosthetic joint infections in hip replacement patients. However, it did not significantly improve knee surgeries, suggesting the need for further research on this subgroup. Also, we found no significant difference in re-revision rates or mortality between DALC and SALC. Hence, the clinical advantage of DALC may be limited to reducing infections and no other long-term outcomes, such as reoperations or patient survival. We recommend future large-scale randomized controlled trials focusing on the efficacy, cost-benefit analyses, and long-term effects of dual antibiotic therapies.”

Further reading:

Ahmed E A, Muharib R. Alruwaili K, Abdulhamid F. Alanazi A, et al. (December 06, 2024) Efficacy and Safety of Dual vs Single Antibiotic-Loaded Cement in Bone Fracture Management: A Systematic Review and Meta-Analysis. Cureus 16(12): e75208. DOI 10.7759/cureus.75208