Dual antibiotic-loaded bone cement reduces surgical site infection risk in cemented hip arthroplasty patients compared to single cement.

This systematic review and meta-analysis examined the efficacy of dual antibiotic-loaded bone cement compared to single antibiotic-loaded bone cement in preventing surgical site infections. The study population comprised 36939 patients undergoing cemented hip arthroplasty, which included both hemiarthroplasty and total hip arthroplasty procedures. The analysis aggregated data to determine the impact of the intervention on infection rates across these surgical contexts.

The primary outcome measured was the risk of surgical site infections. The meta-analysis found a significantly lower risk of surgical site infections with dual antibiotic-loaded bone cement compared to single antibiotic-loaded bone cement. The pooled odds ratio was 0.64 with a 95% confidence interval of 0.47 to 0.87 and a P value less than 0.001. This indicates a substantial reduction in infection risk associated with the use of dual cement formulations.

Subgroup analysis revealed distinct outcomes based on the specific type of arthroplasty performed. In patients undergoing hemiarthroplasty, there was a significant reduction in the risk of surgical site infections with dual antibiotic-loaded bone cement compared to single antibiotic-loaded bone cement. The odds ratio for this subgroup was 0.48 with a 95% confidence interval of 0.34 to 0.69 and a P value less than 0.001. Conversely, the difference was not statistically significant for patients undergoing total hip arthroplasty and revision total hip arthroplasty. No specific effect size or confidence interval was reported for this latter subgroup.

The absolute numbers provided for the primary analysis indicated that 5830 patients received dual antibiotic-loaded bone cement while 31109 patients received single antibiotic-loaded bone cement. These figures represent the total sample size utilized to calculate the pooled estimates for the primary outcome. The data suggests a broad application of these materials across a large patient cohort.

Safety and tolerability findings were not reported in the source data. No specific adverse events, serious adverse events, discontinuations, or tolerability metrics were available for inclusion in the synthesis. Consequently, the safety profile of dual antibiotic-loaded bone cement relative to single antibiotic-loaded bone cement remains undefined based on this specific evidence set.

The practice relevance of these findings supports the consideration of dual antibiotic-loaded bone cement in high-risk patients undergoing hip arthroplasty to optimize infection prevention and management. This approach aligns with the goal of reducing postoperative complications in orthopedic surgery. However, the lack of significant difference in total hip arthroplasty and revision cases suggests that the benefit may be more pronounced in hemiarthroplasty or specific high-risk scenarios.

Key questions remain unanswered regarding the long-term safety profile and the specific mechanisms driving the observed reduction in hemiarthroplasty but not total hip arthroplasty. The absence of reported safety data limits the ability to fully assess the risk-benefit ratio for clinicians. Further research is needed to clarify these discrepancies and to provide comprehensive safety information for decision-making.