Single versus dual antibiotic-loaded bone cement in hip fracture arthroplasty: a cohort study of 56,434 hip arthroplasties from the Dutch Arthroplasty Register

This Dutch registry study of 56,434 cemented hip fracture arthroplasties compared single versus dual antibiotic-loaded bone cement (ALBC) for preventing periprosthetic joint infection. After adjustment, dual ALBC was not associated with lower all-cause revision (HR 1.2, CI 0.9-1.5), but was associated with a slightly higher rate of revision for infection (HR 1.6, CI 1.0-2.5) and mortality (HR 1.2, CI 1.1-1.2) compared with single ALBC. The authors attribute the mortality signal to residual confounding (dual ALBC likely used in frailer patients) rather than a true causal effect of the cement.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersThis is one of the largest real-world datasets addressing whether dual ALBC reduces infection after hip fracture arthroplasty, a question with major cost and antibiotic-stewardship implications for a very common procedure.

Presenting this at rounds? Start here

• ?Given the lack of demonstrated infection-prevention benefit and higher cost, should surgeons who currently use dual ALBC routinely in hip fracture arthroplasty reconsider switching to single ALBC?
• ?How should indication bias and unmeasured frailty be factored into decisions about cement selection for high-risk hip fracture patients while awaiting trial data like DAICY?