Is the use of dual antibiotic loaded bone cement associated with a reduced risk of revision and mortality after hemi and total hip arthroplasty for fracture, compared to single antibiotic cement? A register-based evaluation of current practice

Approval date: February 28th 2025
Starting date: March 21th 2025

WP Zijlstra, C Yoon, M Wouthuyzen-Bakker, L van Steenbergen, K Bos

Research proposal abstract:
Hip arthroplasty generally yields reliable and excellent results in most patients. Although the risk is small, periprosthetic joint infection (PJI) can result in devastating results for the patient, requiring repetitive surgery and long periods of antibiotic treatment. Multiple perioperative strategies have been aiming to minimize the risk of PJI, but the risk for PJI has not been eliminated yet, especially in vulnerable patients. Patients with a fractured neck of femur are known to be vulnerable and often require a hemi or total hip replacement as treatment to regain their mobility. Their risk of PJI is twice as high as patients with osteoarthritis (e.g. 3-4% versus 1-2%). Especially in these vulnerable patients, all efforts should be made to avoid PJI. One of the possible surgical strategies is the use of dual antibiotic loaded bone cement (DALBC; e.g. gentamycin+clindamycin, or gentamycin+vancomycin) instead of single antibiotic cement (SALBC; e.g. only gentamycin). Previous trials have shown conflicting results regarding a potential benefit of DALBC. As the use of DALBC has increased over de last 5 years, the numbers in the LROI may now be sufficient to review a possible benefit of DALBC in hip arthroplasty patients with real-world data.

In this study we aim to determine: 
(1) The risk of revision for any reason after hemi and total hip arthroplasty for fracture in the Netherlands, and the risk of revision for infection especially. 
(2) The risks of revision as above, comparing single antibiotic cement (SALBC) to dual antibiotic cement (DALBC) use. 
(3) Mortality 1 and 2 years after hip arthroplasty for fracture in the Netherlands, comparing SALBC to DALBC use.