Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis
ABSTRACT Background Antibiotic‐loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic‐loaded cement (DALC) and single antibiotic‐loaded cement (SALC). Objective This systematic...
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| Format: | Article |
| Language: | English |
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Wiley
2025-07-01
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| Series: | Orthopaedic Surgery |
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| Online Access: | https://doi.org/10.1111/os.70056 |
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| author | Cara Mohammed Zuzanna Sandhu Anjani Mahesh Kumar Cherukuri Jeries Sayegh Adeeb Khouri Kuruba Venkataramana Aman Saswat Sahoo Kabilesh Jothilingam Seba Sayed Muhammed Zain Elahi Muhammad Ehsan Lawrence Sena Tuglo Raakesh Goalan |
| author_facet | Cara Mohammed Zuzanna Sandhu Anjani Mahesh Kumar Cherukuri Jeries Sayegh Adeeb Khouri Kuruba Venkataramana Aman Saswat Sahoo Kabilesh Jothilingam Seba Sayed Muhammed Zain Elahi Muhammad Ehsan Lawrence Sena Tuglo Raakesh Goalan |
| author_sort | Cara Mohammed |
| collection | DOAJ |
| description | ABSTRACT Background Antibiotic‐loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic‐loaded cement (DALC) and single antibiotic‐loaded cement (SALC). Objective This systematic review and meta‐analysis compare the efficacy of DALC and SALC for hip hemiarthroplasty. Methods For this systematic review, a search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. Grey literature such as ProQuest Dissertations and Theses Global (PQDT) was also explored. The inclusion criteria comprised randomized controlled trials (RCTs) or comparative observational studies, and patients undergoing hip hemiarthroplasty with DALC or SALC. Newcastle–Ottawa Scale (NOS) and RoB 2.0 tools were used for risk of bias assessment in observational and RCTs, respectively. Review Manager (RevMan, version 5.4.1; The Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. The primary outcome was the incidence of deep SSIs. Results A total of five articles, including 28,418 participants, met the inclusion criteria. Three of the included studies were retrospective studies, one quasi‐randomized study, and one RCT. The primary outcome revealed that DALC was associated with a statistically significant reduction in deep SSIs compared to SALC (RR, 0.47; 95% CI, 0.29–0.76; p = 0.002; I 2 = 27%). Subgroup analysis based on the study design did not show a significant difference for deep SSIs (p = 0.29). The majority of the secondary outcomes, such as superficial SSIs, mortality, participants with ≥ 1 complication, or antibiotic use, did not show any significant difference. However, DALC significantly lowered the risk of any infection (RR, 0.55; 95% CI, 0.38–0.79; p = 0.001; I 2 = 27%). Conclusion In conclusion, DALC can significantly reduce the risk of SSIs and the overall rate of any infection in hip hemiarthroplasty. A limitation of this study is that RCTs were pooled with observational studies, which decreased the power of analysis. Therefore, further research, including large RCTs, is needed to validate these findings. |
| format | Article |
| id | doaj-art-a05f70bcafa7471697f3e45e5d089afb |
| institution | Kabale University |
| issn | 1757-7853 1757-7861 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
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| series | Orthopaedic Surgery |
| spelling | doaj-art-a05f70bcafa7471697f3e45e5d089afb2025-08-20T03:29:14ZengWileyOrthopaedic Surgery1757-78531757-78612025-07-011772103211110.1111/os.70056Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐AnalysisCara Mohammed0Zuzanna Sandhu1Anjani Mahesh Kumar Cherukuri2Jeries Sayegh Adeeb Khouri3Kuruba Venkataramana4Aman Saswat Sahoo5Kabilesh Jothilingam6Seba Sayed Muhammed7Zain Elahi8Muhammad Ehsan9Lawrence Sena Tuglo10Raakesh Goalan11Department of Orthopaedic Surgery Sangre Grande Hospital Sangre Grande Trinidad and TobagoDepartment of Neurosciences University Hospital Coventry & Warwickshire NHS Trust Coventry UKDepartment of Orthopedic Surgery Guntur Medical College Guntur IndiaAlHussain New Salt Hospital As‐Salt JordanDepartment of Orthopedic Surgery AIIMS Mangalagiri IndiaSchool of Medicine and Dentistry, University of Central Lancashire Preston UKBAU International University Batumi GeorgiaBAU International University Batumi GeorgiaMid and South Essex NHS Foundation Trust Westcliff‐on‐Sea Essex UKDepartment of Medicine King Edward Medical University Lahore PakistanDepartment of Nutrition and Dietetics School of Allied Health Sciences, University of Health and Allied Sciences Ho GhanaUniversity of the West Indies St Augustine Trinidad and TobagoABSTRACT Background Antibiotic‐loaded cement (ALC) is often used to reduce the risk of surgical site infections (SSIs) in hip hemiarthroplasty; however, controversy exists regarding the use of dual antibiotic‐loaded cement (DALC) and single antibiotic‐loaded cement (SALC). Objective This systematic review and meta‐analysis compare the efficacy of DALC and SALC for hip hemiarthroplasty. Methods For this systematic review, a search was undertaken in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, and ClinicalTrials.gov. Grey literature such as ProQuest Dissertations and Theses Global (PQDT) was also explored. The inclusion criteria comprised randomized controlled trials (RCTs) or comparative observational studies, and patients undergoing hip hemiarthroplasty with DALC or SALC. Newcastle–Ottawa Scale (NOS) and RoB 2.0 tools were used for risk of bias assessment in observational and RCTs, respectively. Review Manager (RevMan, version 5.4.1; The Cochrane Collaboration, Copenhagen, Denmark) was used for statistical analysis. The primary outcome was the incidence of deep SSIs. Results A total of five articles, including 28,418 participants, met the inclusion criteria. Three of the included studies were retrospective studies, one quasi‐randomized study, and one RCT. The primary outcome revealed that DALC was associated with a statistically significant reduction in deep SSIs compared to SALC (RR, 0.47; 95% CI, 0.29–0.76; p = 0.002; I 2 = 27%). Subgroup analysis based on the study design did not show a significant difference for deep SSIs (p = 0.29). The majority of the secondary outcomes, such as superficial SSIs, mortality, participants with ≥ 1 complication, or antibiotic use, did not show any significant difference. However, DALC significantly lowered the risk of any infection (RR, 0.55; 95% CI, 0.38–0.79; p = 0.001; I 2 = 27%). Conclusion In conclusion, DALC can significantly reduce the risk of SSIs and the overall rate of any infection in hip hemiarthroplasty. A limitation of this study is that RCTs were pooled with observational studies, which decreased the power of analysis. Therefore, further research, including large RCTs, is needed to validate these findings.https://doi.org/10.1111/os.70056antibiotic‐loaded bone cement (ALBC)cemented arthroplastydeep surgical site infectionssurgical site infections (SSIs) |
| spellingShingle | Cara Mohammed Zuzanna Sandhu Anjani Mahesh Kumar Cherukuri Jeries Sayegh Adeeb Khouri Kuruba Venkataramana Aman Saswat Sahoo Kabilesh Jothilingam Seba Sayed Muhammed Zain Elahi Muhammad Ehsan Lawrence Sena Tuglo Raakesh Goalan Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis Orthopaedic Surgery antibiotic‐loaded bone cement (ALBC) cemented arthroplasty deep surgical site infections surgical site infections (SSIs) |
| title | Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis |
| title_full | Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis |
| title_fullStr | Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis |
| title_full_unstemmed | Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis |
| title_short | Dual‐ vs. Single‐Antibiotic Loaded Cement for Hip Hemiarthroplasty: A Systematic Review and Meta‐Analysis |
| title_sort | dual vs single antibiotic loaded cement for hip hemiarthroplasty a systematic review and meta analysis |
| topic | antibiotic‐loaded bone cement (ALBC) cemented arthroplasty deep surgical site infections surgical site infections (SSIs) |
| url | https://doi.org/10.1111/os.70056 |
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