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
Processing time: 246 Days and 15.3 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.