Arthroplasty infection rates in fractured neck of femur: single vs dual antibiotic cement

Ann R Coll Surg Engl. 2019 Sep;101(7):514-518. doi: 10.1308/rcsann.2019.0054. Epub 2019 Jun 3.

Abstract

Introduction: Mortality rates following hip arthroplasty range between 10% and 40% after 12 months. A higher rate is attributed to postoperative complications, of which surgical site infection is one of the most significant. In an effort to reduce surgical site infection following arthroplasty, antibiotics can be added to the cement used. The primary aim of this study was to determine whether dual antibiotic impregnated cement can reduce the rate of deep surgical site infection in patients following cemented arthroplasty for fractured neck of femur compared with single antibiotic impregnated cement. The secondary aim was to compare the rate of superficial surgical site infection in single compared with dual antibiotic cement.

Materials and methods: A total of 206 patients were included. Group 1 included 108 retrospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using single antibiotic impregnated cement. Group 2 included 98 prospective patients who underwent arthroplasty for neck of femur fracture over a 12-month period using dual antibiotic impregnated cement. The rates of deep and superficial surgical site infection were investigated.

Results: Group 1 had a deep surgical site infection rate of 2.9% (n = 3), Group 2 had a deep surgical site infection rate of 0% (n = 0). Group 1 had a superficial surgical site infection rate of 3.7% (n = 4), Group 2 had a superficial surgical site infection rate of 5.1% (n = 5).

Conclusion: Dual antibiotic cement reduced the rate of deep surgical site infection compared with conventional single antibiotic cement in arthroplasty for fractured neck of femur. Only a marginal difference in superficial surgical site infection was observed.

Keywords: Antibiotic cement; Arthroplasty; Femoral neck fracture; Infection.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Antibiotic Prophylaxis / methods
  • Arthritis, Infectious / epidemiology*
  • Arthritis, Infectious / etiology
  • Arthritis, Infectious / prevention & control
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Bone Cements / therapeutic use*
  • Drug Therapy, Combination / methods
  • Female
  • Femoral Neck Fractures / mortality
  • Femoral Neck Fractures / surgery
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Prosthesis-Related Infections / epidemiology*
  • Prosthesis-Related Infections / etiology
  • Prosthesis-Related Infections / prevention & control
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Surgical Wound Infection / epidemiology*
  • Surgical Wound Infection / etiology
  • Surgical Wound Infection / prevention & control
  • Survival Rate
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Bone Cements