Single versus dual antibiotic-loaded bone cement in hip fracture arthroplasty: a cohort study of 56,434 hip arthroplasties from the Dutch Arthroplasty Register
DOI:
https://doi.org/10.2340/17453674.2026.46527Keywords:
Antibiotic-loaded bone cement, Arthroplasty, Fractures, Hip, Infection, Periprosthetic joint infectionAbstract
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.
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Copyright (c) 2026 Seung-Jae Yoon, Laura van Marle, Liza N van Steenbergen, Pieter K Bos, Paul C Jutte, Marjan Wouthuyzen-Bakker, Wierd P Zijlstra
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