Periprosthetic infection in elderly patients treated with hemiarthroplasty of the hip following intracapsular fracture. Should be use antibiotic-loaded bone cement?

Abstract

IntroductionProsthetic infections are a potentially devastating complication, especially in elderly patients. Antibiotic-loaded bone cement has been used both as a treatment and prophylaxis in prosthetic infection, and its use is not well documented in the prophylaxis of infection in patients who have suffered a hip fracture. MaterialA retrospective descriptive was performed. The data were obtained from all the patients who underwent hip hemiarthroplasty due to a subcapital fracture between 2011 and 2017 (N=241). An epidemiological study of the patients studied was carried out. We analysed the incidence of periprosthetic infection in the groups treated with cement without antibiotic and antibiotic-loaded bone cement, as well as the protective effect of the antibiotic-loaded bone cement. At the same time, a pilot cost analysis study was carried out. ResultsIn the group that received antibiotic-loaded bone cement (n=94) there were 8 infections (8%), while in the group with cement without antibiotic (n=147) there were 28 infections (19%). The odds ratio (OR) was calculated, showing a 55.3% reduction in the risk of developing late infection in the group that received cement with antibiotic (95% CI: 6.2–78.7 %) (P=.0025). The use of antibiotic-loaded bone cement led to significant cost savings per patient. ConclusionsThe use of antibiotic-loaded bone cement is a protective factor in the development of late infection after hip hemiarthroplasty surgery in elderly patients with hip fracture.