PROPHYLACTIC USE OF ANTIBIOTIC-LOADED BONE CEMENT IN PRIMARY HIP REPLACEMENT: A SYSTEMATIC REVIEW OF THE LITERATURE AND META-ANALYSIS

G. Bettinelli¹, M. Alessio-Mazzola² , C. Santacroce³, A. Belluati⁴, V. Salini³, G. Placella³

¹ Azienda Ospedaliera Carlo Poma, Orthopaedic and Trauma Unit, Mantua, MN, Italy
² IRCCS Ospedale San Raffaele, Milan, Italy
³ Università Vita-Salute San Raffaele, Milan, Italy
⁴ Orthopaedic and Trauma Department, Hospital Santa Maria delle Croci, Ravenna, Italy

Correspondence to:

Journal of Orthopedics 2023 September-December; 15(3): 117-123

Received: 3 September 2023 Accepted: 6 October 2023

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Abstract

Periprosthetic joint infection (PJI) is a challenging complication following joint replacement and represents a significant health expense. Literature comparing antibiotic-loaded bone cement (ALBC) and plain bone cement (PBC) for total hip replacement is lacking and inconclusive. This research aims to meta-analyze the available literature in order to state if ALBC is superior to PBC for the prevention of PJI and, therefore, justify its widespread use in primary hip replacement. A systematic review of the literature was carried out about survival, in terms of septic revision, of cemented primary hip replacement, comparing ALBC and PBC following PRISMA guidelines. Articles published before 2005 have been excluded because cementing techniques have significantly improved over the last few years. The indication for surgery was both for hip osteoarthritis and for femoral neck fracture. National registry studies, cohort studies, and case series were included in this systematic review. Five articles were eligible for the meta-analysis, with 502.702 hip replacements. The forest plot comparing ALBC and PBC, with a CI of 99%, was in favor of the usage of antibiotics [χ²=5.88, Risk Ratio=1.55 (1.29, 1.85)]. The sub-group analysis of the effect of ALBC when compared to PBC was not possible, based on total and partial replacement, nor the surgical indication. This meta-analysis, critically analyzing the available literature, proved the superiority and rationality of ALBC usage vs PBC. The present article proved a statistically significant reduction in PJI rate in primary hip replacements cementing with ALBC compared to PBC, but strong recommendations cannot be made.  Further prospective randomized trials are requested to confirm the efficacy of ALBC in preventing PJI.

Keywords: antibiotic bone cement, hip, infection, prosthesis, revision