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

Dominik Szymski; Nike Walter; Paula Krull; Oliver Melsheimer; Alexander Grimberg; Volker Alt; Arnd Steinbrück; Markus Rupp

doi:10.1302/1358-992X.2023.17.005

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General Orthopaedics

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

The European Bone and Joint Infection Society (EBJIS) Meeting, Basel, Switzerland, 12–14 October 2023.

Dominik Szymski
Nike Walter
Paula Krull
Oliver Melsheimer
Alexander Grimberg
Volker Alt
Arnd Steinbrück
Markus Rupp

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

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. Orthop Procs. 2023;105-B(SUPP_17):5-5. doi:10.1302/1358-992X.2023.17.005

Szymski, Dominik, 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.” Orthopaedic Proceedings, vol. 105-B, no. SUPP_17, 2023, pp. 5-5., https://doi.org/10.1302/1358-992X.2023.17.005

Szymski, D., Walter, N., Krull, P., Melsheimer, O., Grimberg, A., Alt, V., Steinbrück, A., & Rupp, M. (2023). 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. Orthopaedic Proceedings, 105-B(SUPP_17), 5-5. https://doi.org/10.1302/1358-992X.2023.17.005

Szymski, D., Walter, N., Krull, P., Melsheimer, O., Grimberg, A., Alt, V. et al. (2023) “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.” Orthopaedic Proceedings, 105-B(SUPP_17), pp. 5-5. Available at: https://doi.org/10.1302/1358-992X.2023.17.005

Szymski, Dominik, Nike Walter, Paula Krull, Oliver Melsheimer, Alexander Grimberg, Volker Alt, Arnd Steinbrück, and Markus Rupp. “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.” Orthopaedic Proceedings 105-B, no. SUPP_17 (2023): 5-5. https://doi.org/10.1302/1358-992X.2023.17.005

Szymski D, Walter N, Krull P, Melsheimer O, Grimberg A, Alt V, 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. Orthop Procs. 2023 Nov 24;105-B(SUPP_17):5-5. https://doi.org/10.1302/1358-992X.2023.17.005

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Abstract

Aim

The aim of this investigation was to compare risk of infection in both cemented and cementless hemiarthroplasty (HA) as well as 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 cementless protheses and paired according to age, sex, body mass index (BMI), and the Elixhauser score using Mahalanobis distance matching.

Results

Overall in 13,612 cases of intracapsular femoral neck fracture, with 9,110 (66.9 %) HAs and 4502 (33.1 %) THAs were analyzed. Infection rate in HA was significantly reduced in cases with use of antibiotic-loaded cement compared to cementless fixated prosthesis (p=0.013). In patients with THA no statistical difference between cemented and cementless prothesis was registered, however after one year 2.4 % of infections were detected in cementless 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 cementless HA. BMI (p=0.001) and Elixhauser-Comorbidity-Score (p<0.003) were identified as risk factors of PJI, while in THA also cemented prosthesis demonstrated within the first 30 days an increased risk (HR=2.728; p=0.010).

Conclusion

The rate of infection after intracapsular femoral neck fracture was significantly reduced in patients treated by antibiotic-loaded cemented hemiarthroplasty. In particular 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.

Email: dominik.szymski@ukr.de