Arthroplasty infection rates in fractured neck of femur: single vs dual antibiotic cement
Savage P, McCormick M, Al-Dadah O Ann R Coll Surg Engl 2019; 101: 514–518.
At a Glance
No deep surgical site infections (SSI) were observed when prostheses had been cemented with COPAL® G+C vs. 2.8% deep SSI when prostheses were fixed with low-dose single antibiotic-loaded bone cement (SALBC) at 12 months of follow-up
Superficial SSI rate of 5.1% in the COPAL® G+C group vs. 3.7% in the SALBC group at 12 months of follow-up
Study details
Retrospective and prospective analysis of 206 patients with cemented (hemi-)arthroplasty after fractured neck of femur (FNOF)
Comparison of prothesis fixation with high-dose dual antibiotic-loaded bone cement (DALBC) COPAL® G+C vs. SALBC
Endpoints: deep and superficial SSI within 12 months following surgery
Study Design: Analysis of 206 patients with cemented (hemi-)arthroplasty after FNOF: including 108 retrospective patients fixed with SALBC and 98 prospective patients fixed with COPAL G+C. Primary endpoint was deep SSI at 12 month after surgery. Figure based on Savage et al. (2019)
Location
South Tyneside District Hospital, United Kingdom
Endpoints
Rate of deep and superficial SSI
Similar patient characteristics in both study groups
Patient Characteristics: Breakdown of demographics between SALBC group (green) and COPAL G+C group (blue). Table adapted from Savage et al. (2019)
Clinically* significant reduction of deep SSI over 12 months when prostheses were fixed with COPAL® G+C vs. SALBC
Infection Rates (after 12 months): Reduction in deep SSI from 2.8% to 0% when treated with COPAL G+C (blue) compared to SALBC (green). Superficial SSI was 3.7% when treated with SALBC (green) and 5.1% when treated with COPAL G+C (blue). Figure based on Savage et al. (2019)
All 3 deep SSI were observed in the group of patients who had undergone cemented hemiarthroplasty with SALBC whereas more superficial and easier to treat SSI were observed in the COPAL® G+C group
Microbiology culture results from patients with deep SSI showed growth of S. aureus, with no bacterial growth and coliforms
SSI According to Surgeries Performed: Of the patients treated with SALBC (green), 95 patients underwent hemiarthroplasty (HA) and 13 patients underwent total hip arthroplasty (THA); Of the HA patients, 3 presented with deep SSI and 4 with superficial SSI, while no patients undergoing THA presented any SSI. Of the patients treated with COPAL G+C (blue), 85 patients underwent HA and 13 patients underwent THA; 4 of the HA patients as well as 1 of the THA patients presented with superficial SSI, while 0 presented with deep SSI. Table adapted from Savage et al. (2019)
* The cohort considered was too small, which is why no statistical significance could be calculated, nevertheless the authors identified a clinical significance.
DALBC – High-dose dual antibiotic-loaded bone cement
F - Female
FNOF – Fractured neck of femur
HA - Hemiarthroplasty
L – Left-handed
M – Male
n – Study population
R – Right-handed
SALBC – Low-dose single antibiotic-loaded bone cement
SSI – Surgical site infections
THA – Total hip arthroplasty