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

Abstract

Background and purpose Hip fracture treatment with (hemi)arthroplasty carries a risk of periprosthetic joint infection (PJI), which may be reduced by using dual antibiotic-loaded bone cement (ALBC). We aimed to compare the rate of all-cause revision, revision for infection, and mortality following single or dual ALBC use in hip fracture arthroplasty. Methods From the Dutch Arthroplasty Register, we identified all cemented hemiarthroplasties (HA) and total hip arthroplasties (THA) performed in the period 2007–2024 for proximal femoral fracture. Crude cumulative incidences of all-cause and infection revision were estimated using competing risk survival analyses with death as competing event. Mortality was estimated using Kaplan–Meier analysis. Cause-specific Cox regression models adjusting for age, year of surgery, history of previous surgeries, and American Society of Anesthesiologists (ASA) classification estimated hazard ratios (HRs). Results We analyzed 56,434 hip arthroplasties, of which 1,651 used dual ALBC. 1-year crude cumulative incidences were similar across groups for all-cause revision, infection revision, and mortality. After adjustment, dual ALBC was not associated with a reduced rate of all-cause revision (HR 1.2, 95% confidence interval [CI] 0.9–1.5]) compared with single ALBC. Dual ALBC was associated with a modestly higher revision for infection (HR 1.6, CI 1.0–2.5) and mortality in HA (HR 1.2, CI 1.1–1.2). Conclusion Dual ALBC was not associated with lower revision rates compared with single ALBC but a modestly higher revision rate was noted for infection and mortality following hip arthroplasty after hip fracture.