Clinical Trials Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Feb 18, 2022; 13(2): 150-159
Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.150
Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty – should we use antibiotic-loaded bone cement?
Diana Crego-Vita, Daniel Aedo-Martín, Rafael Garcia-Cañas, Andrea Espigares-Correa, Coral Sánchez-Pérez, Christof Ernst Berberich
Diana Crego-Vita, Rafael Garcia-Cañas, Department of Orthopaedic and Trauma Surgery, Hospital Central de la Defensa Gómez Ulla, Madrid 28047, Spain
Daniel Aedo-Martín, Department of Orthopaedic and Trauma Surgery, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Coslada 28822, Madrid, Spain
Andrea Espigares-Correa, Department of Orthopeadic and Trauma Surgery, Hospital Central de la Defensa Gómez Ulla, Madrid 28047, Spain
Coral Sánchez-Pérez, Department of Orthopeadic and Trauma Surgery, General University Hospital Gregorio Maranon, Madrid 28007, Spain
Christof Ernst Berberich, Department of Medical Training, Heraeus Medical GmbH, Wehrheim 612173, Hessen, Germany
Author contributions: Crego-Vita D has been the supervisor and principal investigator in this IIT; Aedo-Martin D, García-Canas R, Espigares-Correa A and Sánchez-Pérez C performed the patient consultations, the pre- and postoperative diagnosis and the surgeries; and Berberich C made substantial contributions to the interpretation and discussion of the study and drafted the manuscript.
Institutional review board statement: The first author and principal investigator of the study who submitted the study proposal to the ethics committee received the ethical clearance of this study from the ethical review board of the hospital (see separate certificate).
Informed consent statement: Because of the retrospective nature of the here presented clinical study signed informed consent form is not needed. However, the ethics committee of the Hospital Central de la Defensa Gómez Ulla (Military Hospital Gómez Ulla) has given permission to conduct this study (see certificate).
Conflict-of-interest statement: All authors of this study declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Christof Ernst Berberich, MSc, PhD, Lecturer, Senior Scientist, Department of Medical Training, Heraeus Medical GmbH, Philipp-Reis-Str. 8/11, Wehrheim 612173, Hessen, Germany. christof.berberich@heraeus.com
Received: June 16, 2021
Peer-review started: June 16, 2021
First decision: July 28, 2021
Revised: August 16, 2021
Accepted: January 19, 2022
Article in press: January 19, 2022
Published online: February 18, 2022
Abstract
BACKGROUND

Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture (FNF). Prosthetic joint infection (PJI) is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery. Therefore, priorities should lie in effective preventive strategies to mitigate this burden.

AIM

To determine how much the implementation of the routine use of antibiotic-loaded bone cement (ALBC) as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort.

METHODS

We retrospectively assessed all demographic, health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017; 241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period. The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society (MSIS) criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation. Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013 (non-ALBC group) and into a group receiving an ALBC in the period July 2013 to December 2017 (ALBC group). Data analysis was performed with statistical software. We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the in-hospital infection related treatment costs with the extra costs of use of ALBC.

RESULTS

In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study. There were 8 PJI cases identified in the ALBC group among n = 94 patients, whereas 28 PJI cases were observed in the non-ALBC group among n = 147 patients. The statistical analysis showed an infection risk reduction of 55.3% (in particular due to the avoidance of chronic delayed infections) in the ALBC group (95%CI: 6.2%-78.7%; P = 0.0025). The cost-evaluation analysis demonstrated a considerable cost saving of 3.500 € per patient, related to the implementation of routine use of ALBC in this group.

CONCLUSION

Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties. It was further found to be highly cost-effective.

Keywords: prosthetic joint infection, Femoral neck fracture patients, Hemiarthroplasty, Antibiotic-loaded bone cement, Prophylaxis, Cost-efficacy

Core Tip: Routine use of antibiotic-loaded bone cement in cemented hemiarthroplasties of femoral neck fracture patients has the potential of reducing the infection risk to a significant degree. This measure should be considered on top of the implementation of strict protocols of special pre-, peri- and postoperative orthogeriatric care