Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty – should we use antibiotic-loaded bone cement?

Table 1 Criteria for diagnosis of periprosthetic joint infection according to the Musculoskeletal Infection Society Workgroup[15]

PJI exists when

(1) There is a sinus tract communicating with the prosthesis; or (2) A pathogen is isolated by culture from at least two separate tissue or fluid samples obtained from the affected prosthetic joint; or (3) Four of the following six criteria exist: (a) Elevated serum erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) concentration; (b) Elevated synovial leukocyte count; (c) Elevated synovial neutrophil percentage (PMN%); (d) Presence of purulence in the affected joint; (e) Isolation of a microorganism in one culture of periprosthetic tissue or fluid; or (f) Greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at 9400 magnification.

PJI: Periprosthetic joint infection.

Table 2 Basic clinical data of included patients in study according to the study arms

Items	Plain cement group (n = 147), n (%)	ALBC group (n = 94), n (%)	Both groups, (n = 241), n (%)
Sex
Male	42 (28.6)	29 (30.9)	71 (29.5)
Female	105 (71.4)	65 (69.1)	170 (70.5)
Age
< 80	27 (18.4)	25 (26.6)	52 (21.6)
> 80	120 (81.6)	69 (73.4)	189 (78.4)
Garden classification
I	4 (2.7)	10 (10.6)	14 (5.8)
II	19 (12.9)	8 (8.5)	27 (11.2)
III	47 (32.0)	35 (37.2)	82 (34.0)
IV	77 (52.4)	41 (43.6)	118 (49.0)
Type of trauma
High energy	1 (0.7)	0 (0)	1 (0.4)
Low energy	146 (99.3)	94 (100)	240 (99.6)
Arrival at hospital
Walking	2 (1.4)	5 (5.3)	7 (2.9)
Transferral by relatives	1 (0.7)	1 (1.1)	2 (0.8)
Ambulance	95 (64.6)	75 (79.8)	170 (70.5)
Transferral from other centres	49 (33.3)	13 (13.8)	62 (25.7)
Risk factors for infections
Yes	38 (25.9)	37 (39.4)	75 (31.1)
No	109 (74.1)	57 (60.6)	166 (68.9)

Presentation of femur neck fracture patient characteristics in each group with focus on sex, age, Garden classification of hip fractures, type of trauma, mode of arrival at hospital and risk factors for infection (focus on: presence of inflammatory arthropathies, degree of immunosuppression, presence of diabetes mellitus, previous articular infection, malnutrition, hemophilia and presence of tumors). ALBC: Antibiotic-loaded bone cement.