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Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?: data from the German Arthroplasty Registry

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Authors/contributors
Abstract
The aim of this investigation was to compare risk of infection in both cemented and uncemented hemiarthroplasty (HA) as well as in total hip arthroplasty (THA) following femoral neck fracture. Methods Data collection was performed using the German Arthroplasty Registry (EPRD). In HA and THA following femoral neck fracture, fixation method was divided into cemented and uncemented prostheses and paired according to age, sex, BMI, and the Elixhauser Comorbidity Index using Mahalanobis distance matching. Results Overall in 13,612 cases of intracapsular femoral neck fracture, 9,110 (66.9%) HAs and 4,502 (33.1%) THAs were analyzed. Infection rate in HA was significantly reduced in cases with use of antibiotic-loaded cement compared with uncemented fixated prosthesis (p = 0.013). In patients with THA no statistical difference between cemented and uncemented prosthesis was registered, however after one year 2.4% of infections were detected in uncemented and 2.1% in cemented THA. In the subpopulation of HA after one year, 1.9% of infections were registered in cemented and 2.8% in uncemented HA. BMI (p = 0.001) and Elixhauser Comorbidity Index (p < 0.003) were identified as risk factors of periprosthetic joint infection (PJI), while in THA cemented prosthesis also demonstrated an increased risk within the first 30 days (hazard ratio (HR) = 2.73; p = 0.010). Conclusion The rate of infection after intracapsular femoral neck fracture was statistically significantly reduced in patients treated by antibiotic-loaded cemented HA. Particularly for patients with multiple risk factors for the development of a PJI, the usage of antibiotic-loaded bone cement seems to be a reasonable procedure for prevention of infection. Cite this article: Bone Joint Res  2023;12(5):331–338.
Publication
Bone & Joint Research
Date
2023-5-16
DOI
10.1302/2046-3758.125.BJR-2022-0314.R1
URL
https://boneandjoint.org.uk/doi/10.1302/2046-3758.125.BJR-2022-0314.R1
Notes

Key Question:

  • Does using antibiotic-loaded bone cement reduce the risk of infection after hemiarthroplasty (HA) and total hip arthroplasty (THA) for femoral neck fractures compared to uncemented fixation?

Findings:

  • In 13,612 patients, the use of antibiotic-loaded bone cement in HA significantly reduced the risk of infection compared to uncemented HA.
  • In THA, there was no statistically significant difference in infection rates between cemented and uncemented fixation.

Clinical Implications:

  • Antibiotic-loaded bone cement appears to significantly reduce the risk of infection with HA for femoral neck fractures and could be considered, especially in high-risk patients.
  • More evidence is needed to determine if cement provides an infection benefit for THA.

Strengths:

  • Large sample size from national joint registry.
  • Patients matched on key variables to reduce confounding.
  • Up to 5 years follow-up.

Limitations:

  • Retrospective analysis with possibility of residual confounding.
  • Limited long-term (>5 years) follow-up data due to registry inception in 2012.
  • Possibility of coding errors in registry data.

Level of Evidence Assessment: Moderate Rationale: This is a well-designed retrospective cohort study using registry data. However, as an observational study, it is still subject to potential residual confounding.

Citation
1.
Szymski D, Walter N, Krull P, et al. Infection after intracapsular femoral neck fracture – does antibiotic-loaded bone cement reduce infection risk after hemiarthroplasty and total hip arthroplasty?: data from the German Arthroplasty Registry. Bone Joint Res. 2023;12(5):331-338.
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