Published online Feb 18, 2022. doi: 10.5312/wjo.v13.i2.150
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
Processing time: 246 Days and 15.3 Hours
Use of antibiotic-loaded bone cement (ALBC) for fixation of cemented hip stems in the context of hemiarthroplasties may establish an additional antimicrobial “frontline” in the vulnerable joint compartment.
Given the high periprosthetic joint infection (PJI) rates in this frail patient group of femur neck fracture (FNF), it appears mandatory to consider further effective and easy-to-apply infection preventive measures.
The aim of this study was to compare the PJI rate between patients receiving cemented hip stems with plain cement (non-ALBC group) and patients receiving cemented hip stems with gentamicin-loaded bone cement (ALBC group) in one of the biggest Military hospitals in Spain. The treatment costs of PJI cases in each group were subsequently put in relation to the extra costs related to the routine use of ALBC instead of plain cement.
In total 241 FNF patients who went on to receive cemented hemiarthroplasty during the period from January 2011 to December 2017 were eligible for inclusion in this retrospective study. Patients were stratified into 2 study groups according to the bone cement used for the fixation of the hip stem. The number of PJI cases were analyzed and compared between both groups. Infections were further differentiated between early or chronic delayed infections by the onset of symptoms. Treatment costs in each group were compared with the extra costs related to the use of gentamicin-loaded bone cement in the ALBC group.
Use of ALBC in our hospital setting and in the absence of strict guidelines regulating pre-, peri- and postoperative care of FNF patients has been found to reduce the infection rate by 55%. Despite the extra costs of ALBC use instead of plain cement, this change of surgical practice led to savings of approximately 3500 € per patient.
Use of ALBC was found to be a potent infection prevention factor in FNF patients receiving cemented hemiarthroplasties. It was further found to be highly cost-effective.
Further studies validating the generalizability of our findings under different pre-, peri- and postoperative conditions of FNF patient care are warranted. This does also include the use of dual ALBC to further reduce the still high infection rates.