Ahmed Elsiddig A, Muharib R Alruwaili Khalid, Abdulhamid F Alanazi Abdulmajeed, Alruwaili Abdulelah, Talal M Alruwaili Abdulaziz
Orthopedics and Traumatology, Prince Mutaib bin Abdulaziz Hospital, Sakaka, SAU.
Orthopedics and Traumatology Surgery, Prince Mutaib bin Abdulaziz Hospital, Sakaka, SAU.
Cureus. 2024 Dec 6;16(12):e75208. doi: 10.7759/cureus.75208. eCollection 2024 Dec.
Bone fractures often require arthroplasty, which carries the risk of surgical site infections (SSIs) and prosthetic joint infections (PJIs). Antibiotic-loaded bone cement (ALBC) is commonly used to reduce these risks. Dual antibiotic-loaded cement (DALC) has been proposed as a more effective option compared to single antibiotic-loaded cement (SALC). This systematic review and meta-analysis aimed to compare the efficacy and safety of DALC and SALC in preventing infections and related outcomes in arthroplasty. We conducted a systematic review and meta-analysis comparing DALC and SALC in patients undergoing hip or knee arthroplasty for fractures. The primary outcome was infection rate (SSI and PJI), with secondary outcomes including re-revision rates and mortality. Databases searched included PubMed, Cochrane Library, Scopus, and Google Scholar. Data synthesis was performed using Review Manager Software (RevMan 5.4, Cochrane Methods, London, UK), and odds ratios (OR) with 95% confidence intervals (CI) were calculated. Nine studies comprising 55,672 patients were included. Eight studies focused on hip arthroplasty, and four included knee surgeries. In hip arthroplasty, DALC significantly reduced infection rates compared to SALC (OR, 0.64; 95% CI, 0.49 to 0.83; P = 0.001), with moderate heterogeneity (I² = 52%). However, no significant difference was found in knee arthroplasty (OR, 1.21; 95% CI, 0.87 to 1.70; P = 0.26). Overall, DALC showed a significant reduction in infection rates (OR, 0.81; 95% CI, 0.66 to 1.00; P = 0.05). DALC also significantly reduced deep surgical site infections in hip surgeries (OR, 0.46; 95% CI, 0.33 to 0.66; P < 0.001). No significant differences were observed in re-revision rates for either hip or knee arthroplasty. Mortality rates were also not significantly different between DALC and SALC. DALC appears to reduce infection rates, particularly in hip arthroplasty, compared to SALC. However, no significant differences were found in re-revision or mortality rates. These findings suggest that DALC may offer better prophylaxis in hip surgeries, but further research is needed to explore its broader benefits and cost-effectiveness.
骨折通常需要进行关节成形术，而这存在手术部位感染（SSIs）和人工关节感染（PJIs）的风险。载抗生素骨水泥（ALBC）常用于降低这些风险。与单载抗生素骨水泥（SALC）相比，双载抗生素骨水泥（DALC）已被提出是一种更有效的选择。本系统评价和荟萃分析旨在比较DALC和SALC在预防关节成形术中感染及相关结局方面的疗效和安全性。我们对接受髋或膝关节置换术治疗骨折的患者进行了一项比较DALC和SALC的系统评价和荟萃分析。主要结局是感染率（SSI和PJI），次要结局包括再次翻修率和死亡率。检索的数据库包括PubMed、Cochrane图书馆、Scopus和谷歌学术。使用Review Manager软件（RevMan 5.4，Cochrane方法，英国伦敦）进行数据合成，并计算比值比（OR）及95%置信区间（CI）。纳入了9项研究，共55672例患者。8项研究聚焦于髋关节置换术，4项包括膝关节手术。在髋关节置换术中，与SALC相比，DALC显著降低了感染率（OR，0.64；95%CI，0.49至0.83；P = 0.001），异质性中等（I² = 52%）。然而在膝关节置换术中未发现显著差异（OR，1.21；95%CI，0.87至1.70；P = 0.26）。总体而言，DALC显示感染率显著降低（OR，0.81；95%CI，0.66至1.00；P = 0.05）。DALC还显著降低了髋关节手术中的深部手术部位感染（OR，0.46；95%CI，0.33至0.66；P < 0.001）。在髋关节或膝关节置换术的再次翻修率方面未观察到显著差异。DALC和SALC之间的死亡率也无显著差异。与SALC相比，DALC似乎降低了感染率，尤其是在髋关节置换术中。然而，在再次翻修率或死亡率方面未发现显著差异。这些发现表明DALC可能在髋关节手术中提供更好的预防作用，但需要进一步研究以探索其更广泛的益处和成本效益。
